Basic Information
| Provider Information | |||||||||
| NPI: | 1457352809 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CROMER-TYLER | ||||||||
| FirstName: | ROBBIN | ||||||||
| MiddleName: | |||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 152 PIONEER LN | ||||||||
| Address2: | SUITE F | ||||||||
| City: | BISHOP | ||||||||
| State: | CA | ||||||||
| PostalCode: | 935142563 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7608721606 | ||||||||
| FaxNumber: | 7608723463 | ||||||||
| Practice Location | |||||||||
| Address1: | 152 PIONEER LN | ||||||||
| Address2: | SUITE F | ||||||||
| City: | BISHOP | ||||||||
| State: | CA | ||||||||
| PostalCode: | 935142563 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7608721606 | ||||||||
| FaxNumber: | 7608723463 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/09/2005 | ||||||||
| LastUpdateDate: | 02/17/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | 18600 | AL | N | Allopathic & Osteopathic Physicians | Surgery | 208600000X | 6455 | NV | N | Allopathic & Osteopathic Physicians | Surgery | 208600000X | G87935 | CA | Y | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | 00G879350 | 05 | CA | MEDICAID |