MEDICARE: DR. OWEN LEE ROBINSON M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	G47920	CA

General Provider Information

NPI Number	:	1447246806
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. OWEN LEE ROBINSON M.D.

Provider Business Mailing Address
First Line	:	1141 W REDONDO BEACH BLVD
Second Line	:	SUITE 400
City	:	GARDENA
State	:	CA
Zip	:	90247-3586
Country	:	US
Telephone Number	:	310-538-1381
Fax Number	:	310-538-4900

Provider Business Practice Location Address
First Line	:	1141 W REDONDO BEACH BLVD
Second Line	:	SUITE 400
City	:	GARDENA
State	:	CA
Zip	:	90247-3586
Country	:	US
Telephone Number	:	310-538-1381
Fax Number	:	310-538-4900

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/21/2005
Last Update Date	:	09/29/2010

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