Basic Information
| Provider Information | |||||||||
| NPI: | 1700823176 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ROBERT L. ROBBINS, D.O., LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 400 S MAIN ST | ||||||||
| Address2: | |||||||||
| City: | CHARLESTON | ||||||||
| State: | MO | ||||||||
| PostalCode: | 638341644 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5736833739 | ||||||||
| FaxNumber: | 5736834956 | ||||||||
| Practice Location | |||||||||
| Address1: | 400 S MAIN ST | ||||||||
| Address2: | |||||||||
| City: | CHARLESTON | ||||||||
| State: | MO | ||||||||
| PostalCode: | 638341644 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5736833739 | ||||||||
| FaxNumber: | 5736834956 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/02/2006 | ||||||||
| LastUpdateDate: | 09/06/2007 | ||||||||
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| AuthorizedOfficialLastName: | ROBBINS | ||||||||
| AuthorizedOfficialFirstName: | ROBERT | ||||||||
| AuthorizedOfficialMiddleName: | L. | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER/PHYSICIAN | ||||||||
| AuthorizedOfficialTelephone: | 5736833739 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | JR. | ||||||||
| AuthorizedOfficialCredential: | D.O. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 31640 | MO | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine | 363LF0000X | 116998 | MO | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 261QR1300X | Y | Ambulatory Health Care Facilities | Clinic/Center | Rural Health |
No ID Information.