Provider Demographics
NPI:1073825485
Name:ROBINSON, JEDEDIAH DAVID ALEXANDER (MD)
Entity Type:Individual
Prefix:DR
First Name:JEDEDIAH
Middle Name:DAVID ALEXANDER
Last Name:ROBINSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:217 DIVISION AVE
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97404-5429
Mailing Address - Country:US
Mailing Address - Phone:541-743-9003
Mailing Address - Fax:541-284-0520
Practice Address - Street 1:1711 WILLAMETTE ST STE 302
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-4593
Practice Address - Country:US
Practice Address - Phone:541-743-9003
Practice Address - Fax:541-284-0520
Is Sole Proprietor?:No
Enumeration Date:2010-07-14
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NC2013-02011208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program