Healthcare Provider Details

I. General information

NPI: 1295732782
Provider Name (Legal Business Name): ROBERT MENDELSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/30/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2525 NW LOVEJOY ST STE 200
PORTLAND OR
97210-2863
US

IV. Provider business mailing address

5455 SW 87TH AVE
PORTLAND OR
97225-1713
US

V. Phone/Fax

Practice location:
  • Phone: 503-227-0671
  • Fax: 503-227-0676
Mailing address:
  • Phone: 503-292-3103
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD6412
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: