MEDICARE: MICHAEL DEWAYNE ROBINSON JR.

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	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1598305831
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL DEWAYNE ROBINSON JR.

Provider Business Mailing Address
First Line	:	2314 OLIVER RD APT 226
Second Line	:
City	:	MONROE
State	:	LA
Zip	:	71201-2907
Country	:	US
Telephone Number	:	318-812-4109
Fax Number	:

Provider Business Practice Location Address
First Line	:	1934 CAGLE DR
Second Line	:
City	:	MONROE
State	:	LA
Zip	:	71202-5058
Country	:	US
Telephone Number	:	318-812-4109
Fax Number	:

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

Provider Enumeration Date	:	01/15/2020
Last Update Date	:	01/15/2020

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