Provider Demographics
NPI:1992832851
Name:ROBINSON, LEE DAVID (MD)
Entity Type:Individual
Prefix:
First Name:LEE
Middle Name:DAVID
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 1:4035 MERCANTILE DR
Mailing Address - Street 2:SUITE 206
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97035-2546
Mailing Address - Country:US
Mailing Address - Phone:530-635-8930
Mailing Address - Fax:503-699-7750
Practice Address - Street 1:4035 MERCANTILE DR
Practice Address - Street 2:SUITE 206
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97035-2546
Practice Address - Country:US
Practice Address - Phone:530-635-8930
Practice Address - Fax:503-699-7750
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD15103174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OREO7582Medicare UPIN