Healthcare Provider Details

I. General information

NPI: 1760542419
Provider Name (Legal Business Name): ROBERT R NASH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 07/10/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19400 NW EVERGREEN PKWY
HILLSBORO OR
97124-7031
US

IV. Provider business mailing address

19400 NW EVERGREEN PKWY
HILLSBORO OR
97124-7031
US

V. Phone/Fax

Practice location:
  • Phone: 503-617-2396
  • Fax:
Mailing address:
  • Phone: 503-617-2397
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD26681
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD00046536
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: