Provider Demographics
NPI:1588768717
Name:REDWINE, ROBIN LYNNE (MD)
Entity type:Individual
Prefix:DR
First Name:ROBIN
Middle Name:LYNNE
Last Name:REDWINE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ROBIN
Other - Middle Name:REDWINE
Other - Last Name:KUPPLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 3158
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97208-3158
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1321 NE 99TH AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97220-9437
Practice Address - Country:US
Practice Address - Phone:503-215-9900
Practice Address - Fax:503-215-4025
Is Sole Proprietor?:No
Enumeration Date:2006-09-08
Last Update Date:2013-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD15754207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORP00848603OtherRR MEDICARE - PH&S
OR078204Medicaid
ORR161974Medicare PIN
OR078204Medicaid
ORR144559Medicare PIN
130962Medicare PIN
ORR145838Medicare PIN
ORR145900Medicare PIN
ORR145901Medicare PIN
E36766Medicare UPIN