Provider Demographics
NPI:1144490590
Name:ROBINSON, JACQUELYN AUSTIN (MD)
Entity type:Individual
Prefix:DR
First Name:JACQUELYN
Middle Name:AUSTIN
Last Name:ROBINSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:JACKIE
Other - Middle Name:AUSTIN
Other - Last Name:ROBINSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:4154 S PAUL CIR
Mailing Address - Street 2:
Mailing Address - City:BAY CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48706-2285
Mailing Address - Country:US
Mailing Address - Phone:989-506-7940
Mailing Address - Fax:
Practice Address - Street 1:926 N MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48602-4323
Practice Address - Country:US
Practice Address - Phone:989-753-8453
Practice Address - Fax:989-753-3519
Is Sole Proprietor?:No
Enumeration Date:2008-03-01
Last Update Date:2013-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301087935207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1144490590Medicaid
MI1144490590Medicaid