Basic Information
| Provider Information | |||||||||
| NPI: | 1386677417 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ROBSON | ||||||||
| FirstName: | JEROME | ||||||||
| MiddleName: | A. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 817 COFFEE ROAD | ||||||||
| Address2: | C3 | ||||||||
| City: | MODESTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 95355 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2095299603 | ||||||||
| FaxNumber: | 2095296610 | ||||||||
| Practice Location | |||||||||
| Address1: | 500 COFFEE ROAD | ||||||||
| Address2: | SUITE E | ||||||||
| City: | MODESTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 953554241 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2095211209 | ||||||||
| FaxNumber: | 2095211215 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/09/2006 | ||||||||
| LastUpdateDate: | 10/22/2014 | ||||||||
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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 | 207L00000X | G32736 | CA | Y | Allopathic & Osteopathic Physicians | Anesthesiology | 207LP2900X | G32736 | CA | N | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine |
No ID Information.