Provider Demographics
NPI:1386651560
Name:KOBLISKA, DAVID ROBERT (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:ROBERT
Last Name:KOBLISKA
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 1:890 RIVER RD
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97404-3260
Mailing Address - Country:US
Mailing Address - Phone:541-688-0674
Mailing Address - Fax:541-688-5378
Practice Address - Street 1:890 RIVER RD
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97404-3260
Practice Address - Country:US
Practice Address - Phone:541-688-0674
Practice Address - Fax:541-688-5378
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2023-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD195663207Q00000X
IA29365207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500784346Medicaid
IA5085126Medicaid
FLF58985Medicare UPIN