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Individual

TILDON C ROBINSON IV

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
4424 E FLAMINGO AVE, SUITE 110, NAMPA, ID 83687
(208) 288-4700
(208) 288-4720
Mailing address
3340 E GOLDSTONE WAY, MERIDIAN, ID 83642-1026
(208) 367-5170
(208) 367-5180

Taxonomy

Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
M-8080
ID
207X00000X
Orthopaedic Surgery Physician
M8080
ID

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000010017443
BLUE SHIELD
ID
01
000010029137
BLUE SHIELD
ID
01
000010029138
BLUE SHIELD
ID
01
20003897
MEDICARE RAILROAD
01
37994
BLUE CROSS
ID
01
38620
BLUE CROSS
ID
05
805793900
ID
01
S3119
BLUE CROSS
ID
Enumeration date
10/21/2005
Last updated
10/22/2014
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