Basic Information
| Provider Information | |||||||||
| NPI: | 1841403441 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ROBINSON | ||||||||
| FirstName: | BRYAN | ||||||||
| MiddleName: | S | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 130 E REDSTONE AVE | ||||||||
| Address2: | |||||||||
| City: | CRESTVIEW | ||||||||
| State: | FL | ||||||||
| PostalCode: | 325395348 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8503988725 | ||||||||
| FaxNumber: | 8503988727 | ||||||||
| Practice Location | |||||||||
| Address1: | 202 HILLSIDE DR | ||||||||
| Address2: | |||||||||
| City: | PULASKI | ||||||||
| State: | TN | ||||||||
| PostalCode: | 384784566 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9313634543 | ||||||||
| FaxNumber: | 9313634523 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/08/2007 | ||||||||
| LastUpdateDate: | 05/07/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/07/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | DO0000001829 | TN | Y | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.