Provider Demographics
NPI:1316918006
Name:ROBINSON, JEFFREY D (MD)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:D
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 1:1040 S VAN DYKE RD
Mailing Address - Street 2:SUITE 3
Mailing Address - City:BAD AXE
Mailing Address - State:MI
Mailing Address - Zip Code:48413-9646
Mailing Address - Country:US
Mailing Address - Phone:989-269-9855
Mailing Address - Fax:989-269-4097
Practice Address - Street 1:1040 S VAN DYKE RD
Practice Address - Street 2:STE 3
Practice Address - City:BAD AXE
Practice Address - State:MI
Practice Address - Zip Code:48413
Practice Address - Country:US
Practice Address - Phone:989-269-9855
Practice Address - Fax:989-269-4097
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301052941207W00000X
MIJR052941207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
F30098Medicare UPIN
MION6591OMedicare ID - Type Unspecified