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NPI Code Detail

MEDICARE: DR. ROYCE LEON FONKEN MD

MEDICARE: DR. ROYCE LEON FONKEN MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207W00000XOphthalmology PhysicianMD14414OR

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1134101215
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ROYCE LEON FONKEN MD
Provider Business Mailing Address
First Line : 11086 SE OAK ST
Second Line :
City : MILWAUKIE
State : OR
Zip : 97222-6692
Country : US
Telephone Number : 503-557-2020
Fax Number : 503-344-5110
Provider Business Practice Location Address
First Line : 1306 DIVISION ST
Second Line :
City : OREGON CITY
State : OR
Zip : 97045-1523
Country : US
Telephone Number : 503-656-4221
Fax Number : 503-656-4249
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/15/2005
Last Update Date : 11/17/2009

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