Provider Demographics
NPI:1174538086
Name:WILEY T ROBINSON MD
Entity type:Organization
Organization Name:WILEY T ROBINSON MD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:WILEY
Authorized Official - Middle Name:T
Authorized Official - Last Name:ROBINSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:901-761-6157
Mailing Address - Street 1:PO BOX 17216
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38187-0216
Mailing Address - Country:US
Mailing Address - Phone:901-761-6157
Mailing Address - Fax:
Practice Address - Street 1:6263 POPLAR AVE
Practice Address - Street 2:SUITE 1052
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119-4701
Practice Address - Country:US
Practice Address - Phone:901-761-6157
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-29
Last Update Date:2008-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3389265Medicaid
MS09014770Medicaid
MS09014770Medicaid
TN3370077Medicare PIN