Provider Demographics
NPI:1316059900
Name:ROBINSON, DEREK E (MD)
Entity type:Individual
Prefix:
First Name:DEREK
Middle Name:E
Last Name:ROBINSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3686 GRANDVIEW PKWY
Mailing Address - Street 2:STE 810
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35243-3407
Mailing Address - Country:US
Mailing Address - Phone:205-971-2565
Mailing Address - Fax:205-971-5641
Practice Address - Street 1:3686 GRANDVIEW PKWY
Practice Address - Street 2:STE 810
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35243-3407
Practice Address - Country:US
Practice Address - Phone:205-971-2565
Practice Address - Fax:205-971-5641
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2016-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL11757208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000085728OtherMEDICARE PTAN
AL000085728OtherMEDICARE PTAN