Provider Demographics
NPI:1033117114
Name:ROBINSON, CLYN A (MD)
Entity type:Individual
Prefix:
First Name:CLYN
Middle Name:A
Last Name:ROBINSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1954 FORT UNION BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84121-6882
Mailing Address - Country:US
Mailing Address - Phone:801-993-9512
Mailing Address - Fax:801-733-5618
Practice Address - Street 1:1050 E SOUTH TEMPLE
Practice Address - Street 2:DEPARTMENT OF ANESTHESIA
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84102-1507
Practice Address - Country:US
Practice Address - Phone:801-350-4700
Practice Address - Fax:801-350-4406
Is Sole Proprietor?:No
Enumeration Date:2005-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5568094-1205207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTI06231Medicare UPIN