1144490590 NPI number — DR. JACQUELYN AUSTIN ROBINSON M.D.

Table of content: DR. JACQUELYN AUSTIN ROBINSON M.D. (NPI 1144490590)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144490590 NPI number — DR. JACQUELYN AUSTIN ROBINSON M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROBINSON
Provider First Name:
JACQUELYN
Provider Middle Name:
AUSTIN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ROBINSON
Provider Other First Name:
JACKIE
Provider Other Middle Name:
AUSTIN
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1144490590
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/22/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4154 S PAUL CIR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BAY CITY
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48706-2285
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
989-506-7940
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
926 N MICHIGAN AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAGINAW
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48602-4323
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
989-753-8453
Provider Business Practice Location Address Fax Number:
989-753-3519
Provider Enumeration Date:
03/01/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X , with the licence number:  4301087935 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1144490590 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".