MEDICARE: DR. JERRY JOEL ROBBINS M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	10375	OR

General Provider Information

NPI Number	:	1194874040
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JERRY JOEL ROBBINS M.D.

Provider Business Mailing Address
First Line	:	PO BOX 2847
Second Line	:
City	:	CORVALLIS
State	:	OR
Zip	:	97339-2847
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	930 SW ABBEY ST
Second Line	:
City	:	NEWPORT
State	:	OR
Zip	:	97365-4820
Country	:	US
Telephone Number	:	541-265-2244
Fax Number	:	541-574-4736

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/09/2007
Last Update Date	:	11/03/2020

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