Provider Demographics
NPI:1447352299
Name:ROBSON, RONALD (PA-C)
Entity type:Individual
Prefix:
First Name:RONALD
Middle Name:
Last Name:ROBSON
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2110 COTTAGE ST SE
Mailing Address - Street 2:COTTAGE ST SE
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97302-3712
Mailing Address - Country:US
Mailing Address - Phone:503-585-6501
Mailing Address - Fax:
Practice Address - Street 1:5125 SKYLINE RD S
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97306-9427
Practice Address - Country:US
Practice Address - Phone:503-370-4924
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OROR PA00549363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical