Provider Demographics
NPI:1215637327
Name:ROBINSON, MARK ANTHONY SR
Entity type:Individual
Prefix:MR
First Name:MARK
Middle Name:ANTHONY
Last Name:ROBINSON
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1052
Mailing Address - Street 2:
Mailing Address - City:BAYTOWN
Mailing Address - State:TX
Mailing Address - Zip Code:77522-1052
Mailing Address - Country:US
Mailing Address - Phone:832-421-0783
Mailing Address - Fax:
Practice Address - Street 1:1424 N MARKET LOOP
Practice Address - Street 2:
Practice Address - City:BAYTOWN
Practice Address - State:TX
Practice Address - Zip Code:77521-1413
Practice Address - Country:US
Practice Address - Phone:832-421-0783
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-07
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX27717625343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)