Basic Information
| Provider Information | |||||||||
| NPI: | 1326058538 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ROBBINS | ||||||||
| FirstName: | MARK | ||||||||
| MiddleName: | P | ||||||||
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| Credential: | D.O | ||||||||
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| Mailing Information | |||||||||
| Address1: | 13423 BLANCO ROAD | ||||||||
| Address2: | SUITE 113 | ||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 78216 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2104941100 | ||||||||
| FaxNumber: | 2104941117 | ||||||||
| Practice Location | |||||||||
| Address1: | 5000 BAPTIST HEALTH DR | ||||||||
| Address2: | STE 117 | ||||||||
| City: | SCHERTZ | ||||||||
| State: | TX | ||||||||
| PostalCode: | 781541194 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2106268201 | ||||||||
| FaxNumber: | 2106177985 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/09/2006 | ||||||||
| LastUpdateDate: | 05/03/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | L1442 | TX | Y | Other Service Providers | Specialist | 2083P0011X | L1442 | TX | N | Allopathic & Osteopathic Physicians | Preventive Medicine | Undersea and Hyperbaric Medicine |
ID Information
| ID | Type | State | Issuer | Description | 00645F | 01 | TX | BLUE CROSS BLUE SHIELD OF TEXAS | OTHER | 152820001 | 05 | TX | MEDICAID | 08091310 | 01 | TX | MEDICARE RAILROAD | OTHER |