Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | MD20022 | OR |
NPI | 1003830407 |
---|---|
Provider Name | Robert Rosborough |
First Address | Silverton, OR 97381-1916 |
Second Address | Silverton, OR 97381-1916 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/07/2006 |
Last Update Date | 21/01/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
083444 | (05) | OR |
F89797 | (02) | OR |