Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YX0905X | Otolaryngology/Facial Plastic Surgery | DO23994 | OR |
NPI | 1487679700 |
---|---|
Provider Name | Dr. Mark Stephen Robertson |
First Address | Albany, OR 97321-3415 |
Second Address | Albany, OR 97321-3415 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/07/2006 |
Last Update Date | 03/10/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
286847 | (05) | OR |
G83850 | (02) | OR |