Healthcare Provider Details

I. General information

NPI: 1831012731
Provider Name (Legal Business Name): TYLER ROBINSON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2026
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 MEDICAL PKWY
ENTERPRISE OR
97828-5124
US

IV. Provider business mailing address

601 MEDICAL PKWY
ENTERPRISE OR
97828-5124
US

V. Phone/Fax

Practice location:
  • Phone: 541-426-3111
  • Fax:
Mailing address:
  • Phone: 541-426-3111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License Number201906376RN
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: