Basic Information
| Provider Information | |||||||||
| NPI: | 1447589353 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | JEROME A ROBSON M D INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 817 COFFEE RD | ||||||||
| Address2: | BUILDING C3 | ||||||||
| City: | MODESTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 953554241 | ||||||||
| 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: | 12/24/2009 | ||||||||
| LastUpdateDate: | 09/30/2014 | ||||||||
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| AuthorizedOfficialLastName: | ROBSON | ||||||||
| AuthorizedOfficialFirstName: | JEROME | ||||||||
| AuthorizedOfficialMiddleName: | ANTHONY | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 2095299603 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207LP2900X | G32736 | CA | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine | 207L00000X | G32736 | CA | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | OOG327360 | 05 | CA | MEDICAID |