Provider Demographics
NPI:1548265267
Name:EWING, ROBERT HENRY JR (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:HENRY
Last Name:EWING
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:648 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97520-1710
Mailing Address - Country:US
Mailing Address - Phone:541-482-8100
Mailing Address - Fax:541-488-5081
Practice Address - Street 1:648 N MAIN ST
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:OR
Practice Address - Zip Code:97520-1710
Practice Address - Country:US
Practice Address - Phone:541-482-8100
Practice Address - Fax:541-488-5081
Is Sole Proprietor?:No
Enumeration Date:2005-06-17
Last Update Date:2009-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD18042207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA4164730003OtherCIGNA MEDICARE
OR0000WCPBQOtherMEDICARE GROUP NUMBER
CA180036229OtherRAILROAD MEDICARE
CA18836229OtherRAILROAD MEDICARE
CAGR0063170Medicaid
OR004515001OtherBLUE CROSS/BLUE SHIELD
OR180013711OtherRAILROAD MEDICARE
CAZZZ13445ZOtherMEDICARE GROUP NUMBER
OR053574Medicaid
OR00WCPBQBMedicare PIN
CA180036229OtherRAILROAD MEDICARE
CAA37303Medicare UPIN
OR053574Medicaid
CA18836229OtherRAILROAD MEDICARE