Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YX0905X | Otolaryngology/Facial Plastic Surgery | DO20647 | OR |
NPI | 1649280371 |
---|---|
Provider Name | Dr. Robert Lee Roberts |
First Address | Clackamas, OR 97015-9353 |
Second Address | Clackamas, OR 97015-9353 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/08/2006 |
Last Update Date | 18/03/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
150377 | (05) | OR |
G01591 | (02) |