Provider Demographics
NPI:1487623781
Name:ROBINSON, SANDRA J (DO)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:J
Last Name:ROBINSON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 S INDIANA ST
Mailing Address - Street 2:
Mailing Address - City:CONRAD
Mailing Address - State:MT
Mailing Address - Zip Code:59425-2223
Mailing Address - Country:US
Mailing Address - Phone:330-726-3379
Mailing Address - Fax:406-873-5609
Practice Address - Street 1:707 3RD ST SE
Practice Address - Street 2:
Practice Address - City:CUT BANK
Practice Address - State:MT
Practice Address - Zip Code:59427-3500
Practice Address - Country:US
Practice Address - Phone:406-873-5600
Practice Address - Fax:406-873-5609
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2021-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC201801260207Q00000X
ND10884207Q00000X
OH34.003389207Q00000X
WV859207Q00000X
MI2101009473207Q00000X
MT6793207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVP00890516OtherMEDICARE RR
MTU9116Medicare UPIN
WV2033631Medicare PIN
WV2033632Medicare PIN
WV002514203OtherHIGHMARK BCBS
WV3810018642Medicaid