Healthcare Provider Details

I. General information

NPI: 1598719221
Provider Name (Legal Business Name): ALEXANDER L WOROBEY MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 04/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4805 NE GLISAN
PORTLAND OR
97213
US

IV. Provider business mailing address

5319 SW WESTGATE DR #241
PORTLAND OR
97221-2432
US

V. Phone/Fax

Practice location:
  • Phone: 503-215-1111
  • Fax:
Mailing address:
  • Phone: 503-297-7223
  • Fax: 503-297-7603

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberMD08897
License Number StateOR

VIII. Authorized Official

Name: ALEXANDER L WOROBEY
Title or Position: OWNER PRESIDENT
Credential: MD PC
Phone: 503-297-7223