Healthcare Provider Details

I. General information

NPI: 1942469762
Provider Name (Legal Business Name): ROBBIE BAHL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/06/2008
Last Update Date: 03/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3769 SE MILWAUKIE AVE
PORTLAND OR
97202-3804
US

IV. Provider business mailing address

3769 SE MILWAUKIE AVE
PORTLAND OR
97202-3804
US

V. Phone/Fax

Practice location:
  • Phone: 503-206-8850
  • Fax: 503-296-5820
Mailing address:
  • Phone: 503-206-8850
  • Fax: 503-296-5820

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License NumberMD164885
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: