MEDICARE: DR. HERBERT A KROB 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	2084N0008X	Neuromuscular Medicine (Psychiatry & Neurology) Physician	MD00047890	WA
2	2084N0400X	Neurology Physician	MD00047890	WA
3	2084N0400X	Neurology Physician	MD156921	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
2	0220345	OTHER	WA	L & I
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1780615625
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HERBERT A KROB MD

Provider Business Mailing Address
First Line	:	PO BOX 3158
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97208-3158
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	9135 SW BARNES RD STE 461
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97225-6643
Country	:	US
Telephone Number	:	503-216-1150
Fax Number	:	971-282-0086

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

Provider Enumeration Date	:	07/06/2006
Last Update Date	:	03/19/2021

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