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NPI Code Detail

MEDICARE: RICHARD S POLIN PC

MEDICARE: RICHARD S POLIN PC
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
1207T00000XNeurological Surgery PhysicianMD 25930OR

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11043373996OTHERORINDIVIDUAL NPI

General Provider Information

NPI Number : 1942552062
Entity Type Code : Organization
Provider Name (Legal Business Name) : RICHARD S POLIN PC
Provider Business Mailing Address
First Line : PO BOX 25714
Second Line :
City : PORTLAND
State : OR
Zip : 97298-0714
Country : US
Telephone Number : 503-666-8139
Fax Number : 503-666-3434
Provider Business Practice Location Address
First Line : 24900 SE STARK ST
Second Line : SUITE 208
City : GRESHAM
State : OR
Zip : 97030-3355
Country : US
Telephone Number : 503-666-8139
Fax Number : 503-666-3434
Authorized Official
Title or Position : OWNER
Name : DR. RICHARD SANDERS POLIN
Credential : MD
Telephone Number : 503-666-8149
Provider Enumeration Date : 10/12/2012
Last Update Date : 10/12/2012

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Directions to “RICHARD S POLIN PC ” Practice Location

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