Healthcare Provider Details

I. General information

NPI: 1639187164
Provider Name (Legal Business Name): ROBERT EARL BARTON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2006
Last Update Date: 12/16/2020
Certification Date: 12/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2801 N GANTENBEIN AVE
PORTLAND OR
97227-1623
US

IV. Provider business mailing address

3181 SW SAM JACKSON PARK RD MAILCODE: L-605
PORTLAND OR
97239-3011
US

V. Phone/Fax

Practice location:
  • Phone: 503-413-4350
  • Fax: 503-413-4402
Mailing address:
  • Phone: 503-494-7660
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License NumberMD17157
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: