Provider Demographics
NPI:1285907071
Name:ROBINSON, JUN MARK J
Entity type:Individual
Prefix:MR
First Name:JUN MARK
Middle Name:J
Last Name:ROBINSON
Suffix:
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 1:1722 W 99TH AVE
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99515-4510
Mailing Address - Country:US
Mailing Address - Phone:907-351-5841
Mailing Address - Fax:
Practice Address - Street 1:2121 E 73RD AVE
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99507-2713
Practice Address - Country:US
Practice Address - Phone:907-351-5841
Practice Address - Fax:907-868-1599
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-10
Last Update Date:2012-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK100863310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility