MEDICARE: ROBERT LOUIS DANNENHOFFER 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
1	208000000X	Pediatrics Physician	MD16129	OR

Other Identifiers

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

General Provider Information

NPI Number	:	1306873393
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT LOUIS DANNENHOFFER MD

Provider Business Mailing Address
First Line	:	150 NE KENNETH FORD DR
Second Line	:
City	:	ROSEBURG
State	:	OR
Zip	:	97470-1042
Country	:	US
Telephone Number	:	541-672-9596
Fax Number	:

Provider Business Practice Location Address
First Line	:	150 NE KENNETH FORD DR
Second Line	:
City	:	ROSEBURG
State	:	OR
Zip	:	97470-1042
Country	:	US
Telephone Number	:	541-672-9596
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/27/2006
Last Update Date	:	10/03/2016

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