Provider Demographics
NPI:1265417414
Name:ROBINSON, TRAYCE L (MD)
Entity type:Individual
Prefix:
First Name:TRAYCE
Middle Name:L
Last Name:ROBINSON
Suffix:
Gender:F
Credentials:MD
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 660599
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75266-0599
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1400 N WESTMORELAND RD
Practice Address - Street 2:DEHARO-SALDIVAR HEALTH CENTER
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75211-1656
Practice Address - Country:US
Practice Address - Phone:214-266-0500
Practice Address - Fax:214-266-0554
Is Sole Proprietor?:No
Enumeration Date:2005-12-09
Last Update Date:2012-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK4329208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX100755106Medicaid
TX100755110Medicaid
TX100755108Medicaid
TX100755113Medicaid
TX80416GOtherBLUE CROSS BLUE SHIELD
TX100755116Medicaid
TX100755101Medicaid
TX100755102Medicaid
TX100755105Medicaid
TX100755107Medicaid
TX100755112Medicaid
TX100755114Medicaid
TX100755117Medicaid
TX100755117Medicaid
TX100755102Medicaid