Healthcare Provider Details

I. General information

NPI: 1942552062
Provider Name (Legal Business Name): RICHARD S POLIN PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2012
Last Update Date: 10/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24900 SE STARK ST SUITE 208
GRESHAM OR
97030-3355
US

IV. Provider business mailing address

PO BOX 25714
PORTLAND OR
97298-0714
US

V. Phone/Fax

Practice location:
  • Phone: 503-666-8139
  • Fax: 503-666-3434
Mailing address:
  • Phone: 503-666-8139
  • Fax: 503-666-3434

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License NumberMD 25930
License Number StateOR

VIII. Authorized Official

Name: DR. RICHARD SANDERS POLIN
Title or Position: OWNER
Credential: MD
Phone: 503-666-8149