Healthcare Provider Details

I. General information

NPI: 1073825485
Provider Name (Legal Business Name): JEDEDIAH DAVID ALEXANDER ROBINSON M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2010
Last Update Date: 01/09/2024
Certification Date: 01/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1711 WILLAMETTE ST STE 302
EUGENE OR
97401-4593
US

IV. Provider business mailing address

217 DIVISION AVE
EUGENE OR
97404-5429
US

V. Phone/Fax

Practice location:
  • Phone: 541-743-9003
  • Fax: 541-284-0520
Mailing address:
  • Phone: 541-743-9003
  • Fax: 541-284-0520

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number2013-02011
License Number StateNC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: