Basic Information
| Provider Information | |||||||||
| NPI: | 1003038803 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HITCHCOCK | ||||||||
| FirstName: | ROBYN | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1115 SE 164TH AVE DEPT 358 | ||||||||
| Address2: | |||||||||
| City: | VANCOUVER | ||||||||
| State: | WA | ||||||||
| PostalCode: | 986838004 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3607291253 | ||||||||
| FaxNumber: | 3607293185 | ||||||||
| Practice Location | |||||||||
| Address1: | 400 9TH ST | ||||||||
| Address2: | |||||||||
| City: | FLORENCE | ||||||||
| State: | OR | ||||||||
| PostalCode: | 974397398 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5419978412 | ||||||||
| FaxNumber: | 5419021695 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/02/2007 | ||||||||
| LastUpdateDate: | 03/22/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 03/22/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | MD60865850 | WA | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | 2019-00092 | NC | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | 63707 | MN | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | MD2019-0471 | NM | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | 59931 | AZ | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | M-9382 | ID | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | MD202055 | OR | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 2006702 | 05 | WA | MEDICAID |