Provider Demographics
NPI:1447248448
Name:ROBINSON, RONNIE TODD (CRNA)
Entity type:Individual
Prefix:MR
First Name:RONNIE
Middle Name:TODD
Last Name:ROBINSON
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1988
Mailing Address - Street 2:
Mailing Address - City:PALESTINE
Mailing Address - State:TX
Mailing Address - Zip Code:75802-1988
Mailing Address - Country:US
Mailing Address - Phone:903-675-3202
Mailing Address - Fax:903-677-5586
Practice Address - Street 1:300 WILLOW CREEK PKWY
Practice Address - Street 2:SUITE 130
Practice Address - City:PALESTINE
Practice Address - State:TX
Practice Address - Zip Code:75801-4421
Practice Address - Country:US
Practice Address - Phone:903-723-2465
Practice Address - Fax:903-677-5586
Is Sole Proprietor?:No
Enumeration Date:2005-10-12
Last Update Date:2013-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX657666367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1647273-02Medicaid
8D6725Medicare PIN
TX1647273-02Medicaid