Healthcare Provider Details

I. General information

NPI: 1437610185
Provider Name (Legal Business Name): TRAE ROBISON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2019
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 N GRAHAM ST STE 320
PORTLAND OR
97227-2001
US

IV. Provider business mailing address

PO BOX 4399
PORTLAND OR
97208-4399
US

V. Phone/Fax

Practice location:
  • Phone: 503-413-3690
  • Fax:
Mailing address:
  • Phone: 503-413-3900
  • Fax: 503-413-3710

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License NumberMD229093
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code2086S0120X
TaxonomyPediatric Surgery Physician
License NumberMD229093
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: