Provider Demographics
NPI:1972688828
Name:ROBINSON, BRAD ERIC (MD MPH)
Entity Type:Individual
Prefix:DR
First Name:BRAD
Middle Name:ERIC
Last Name:ROBINSON
Suffix:
Gender:M
Credentials:MD MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2550 NW EDENBOWER BLVD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:ROSEBURG
Mailing Address - State:OR
Mailing Address - Zip Code:97471-8829
Mailing Address - Country:US
Mailing Address - Phone:541-229-4009
Mailing Address - Fax:541-229-3347
Practice Address - Street 1:2550 NW EDENBOWER BLVD
Practice Address - Street 2:SUITE 104
Practice Address - City:ROSEBURG
Practice Address - State:OR
Practice Address - Zip Code:97471-8829
Practice Address - Country:US
Practice Address - Phone:541-229-4009
Practice Address - Fax:541-229-3347
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-26
Last Update Date:2011-09-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ORMD16486207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR009394Medicaid
121579Medicare PIN
E25286Medicare UPIN