Provider Demographics
NPI:1750538864
Name:EDWARDS, ROBIN JAY (CST/CFA)
Entity type:Individual
Prefix:MR
First Name:ROBIN
Middle Name:JAY
Last Name:EDWARDS
Suffix:
Gender:M
Credentials:CST/CFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:82090 BEAR CREEK RD
Mailing Address - Street 2:
Mailing Address - City:CRESWELL
Mailing Address - State:OR
Mailing Address - Zip Code:97426-9486
Mailing Address - Country:US
Mailing Address - Phone:541-895-5176
Mailing Address - Fax:
Practice Address - Street 1:82090 BEAR CREEK RD
Practice Address - Street 2:
Practice Address - City:CRESWELL
Practice Address - State:OR
Practice Address - Zip Code:97426
Practice Address - Country:US
Practice Address - Phone:541-895-5176
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-20
Last Update Date:2008-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORF01120246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant