Healthcare Provider Details

I. General information

NPI: 1871819110
Provider Name (Legal Business Name): ROBERT TAYLOR ENSIGN M.A
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/12/2010
Last Update Date: 04/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2410 SE 121ST AVE
PORTLAND OR
97216-4066
US

IV. Provider business mailing address

2410 SE 121ST AVE
PORTLAND OR
97216-4066
US

V. Phone/Fax

Practice location:
  • Phone: 503-335-5975
  • Fax: 503-335-5974
Mailing address:
  • Phone: 503-335-5975
  • Fax: 503-335-5974

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: