1629330683 NPI number — RANDOLPH C ROBINSON MD

Table of content: DR. BRIAN JOHN EASTRIDGE M.D. (NPI 1679554232)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629330683 NPI number — RANDOLPH C ROBINSON MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RANDOLPH C ROBINSON MD
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1629330683
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/27/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10375 PARK MEADOWS DR
Provider Second Line Business Mailing Address:
SUITE 150
Provider Business Mailing Address City Name:
LONE TREE
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80124-6735
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
303-792-2828
Provider Business Mailing Address Fax Number:
303-792-3328

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10375 PARK MEADOWS DR
Provider Second Line Business Practice Location Address:
SUITE 150
Provider Business Practice Location Address City Name:
LONE TREE
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80124-6735
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-792-2828
Provider Business Practice Location Address Fax Number:
303-792-3328
Provider Enumeration Date:
06/14/2012

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
ROBINSON
Authorized Official First Name:
RANDOLPH
Authorized Official Middle Name:
C
Authorized Official Title or Position:
SOLE PROPRIETOR
Authorized Official Telephone Number:
303-792-2828

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  6757 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1223S0112X , with the licence number: 6757 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2086S0122X , with the licence number: 31972 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 204E00000X , with the licence number: 31972 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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