MEDICARE: ROGER A. PIEPENBRINK DO MPH FACP FACE

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	207R00000X	Internal Medicine Physician	1653641	MI
2	207RE0101X	Endocrinology, Diabetes & Metabolism Physician	DO192691	OR

General Provider Information

NPI Number	:	1962411470
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROGER A. PIEPENBRINK DO MPH FACP FACE

Provider Business Mailing Address
First Line	:	PO BOX 2120
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97208-2120
Country	:	US
Telephone Number	:	541-274-6556
Fax Number	:	541-274-6247

Provider Business Practice Location Address
First Line	:	2821 DAGGETT AVE STE 200
Second Line	:
City	:	KLAMATH FALLS
State	:	OR
Zip	:	97601-1130
Country	:	US
Telephone Number	:	541-274-8400
Fax Number	:	541-274-8405

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

Provider Enumeration Date	:	08/05/2006
Last Update Date	:	11/16/2021

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