Provider Demographics
NPI:1942538350
Name:ROBBINS, D'LORAH L (PA)
Entity type:Individual
Prefix:
First Name:D'LORAH
Middle Name:L
Last Name:ROBBINS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 W COLORADO BLVD STE 943
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75208-2394
Mailing Address - Country:US
Mailing Address - Phone:972-266-8765
Mailing Address - Fax:972-266-5511
Practice Address - Street 1:221 W COLORADO BLVD STE 943
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75208-2394
Practice Address - Country:US
Practice Address - Phone:972-266-8765
Practice Address - Fax:972-266-5511
Is Sole Proprietor?:No
Enumeration Date:2009-11-23
Last Update Date:2014-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013703363A00000X
TXPA08686363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03270995Medicaid
NYJ400027761Medicare PIN