Provider Demographics
NPI:1295981512
Name:ROBY, JASON LOUIS (DO)
Entity type:Individual
Prefix:DR
First Name:JASON
Middle Name:LOUIS
Last Name:ROBY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1050 ISLAND AVE UNIT 615
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92101-7264
Mailing Address - Country:US
Mailing Address - Phone:858-761-3576
Mailing Address - Fax:
Practice Address - Street 1:PARADISE VALLEY HOSPITAL
Practice Address - Street 2:2400 E. 4TH ST.
Practice Address - City:NATIONAL CITY
Practice Address - State:CA
Practice Address - Zip Code:91950
Practice Address - Country:US
Practice Address - Phone:616-470-4158
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-18
Last Update Date:2021-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101021857207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine