Healthcare Provider Details

I. General information

NPI: 1598027286
Provider Name (Legal Business Name): ROBERT CHARLES WINCHELL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/09/2012
Last Update Date: 08/25/2022
Certification Date: 08/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4904 RIVER RD N
KEIZER OR
97303-4540
US

IV. Provider business mailing address

4904 RIVER RD N
KEIZER OR
97303-4540
US

V. Phone/Fax

Practice location:
  • Phone: 407-271-0684
  • Fax: 503-296-2400
Mailing address:
  • Phone: 503-390-2434
  • Fax: 503-981-0423

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD172142
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier500691294
Identifier TypeMEDICAID
Identifier StateOR
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: