Jack Stephen Robinson, MD

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

L3800 Issued in TX

Practice address

18059 Highway 105 W
Suite 100
Montgomery, TX 77356-5802

Phone

(936) 582-5620

Fax

(936) 582-5621

NPI assigned

Sep 23, 2005

Last updated

Mar 7, 2023By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Lake Area Pediatrics

  • Pediatrics Physician
  • Montgomery, TX
  • NPI 1285645911
  Authorized official Same address or phone
• Fadi G. Ghanem, MD PA

  dba Maternal and Family Clinic

  • Family Medicine Physician
  • The Woodlands, TX
  • NPI 1386868875
  NPD (past)
• MFC Medsurg Group LLC

  • Family Medicine Physician
  • The Woodlands, TX
  • NPI 1811338981
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1127433600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1740276856",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "204 SUNSET BLVD",
            "city": "CONROE",
            "state": "TX",
            "postal_code": "773031567",
            "telephone_number": "936-756-3167",
            "fax_number": "936-756-3509"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18059 HIGHWAY 105 W",
            "address_2": "SUITE 100",
            "city": "MONTGOMERY",
            "state": "TX",
            "postal_code": "773565802",
            "telephone_number": "936-582-5620",
            "fax_number": "936-582-5621"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROBINSON",
        "first_name": "JACK",
        "middle_name": "STEPHEN",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-09-23",
        "last_updated": "2023-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "TX",
            "license": "L3800",
            "primary": true
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "CA",
            "license": "G32552",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "158814701",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Robin Kathleen Rivers, D.C.
• Kenneth Wayne Roach
• Miranda Michelle Roach, FNP-C
• Road to Recovery Wound Care LLC
• Amber Robertson, FNP-C
• Madison Alise Rodriguez
• Courtney Roebuck, MT-BC
• Stephanie Roman
• Alejandra Romo
• Rooted Pediatrics PLLC

• Pediatrics Physician in Montgomery, TX
• Providers in Montgomery, TX by specialty
• Pediatrics Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.