Healthcare Provider Details

I. General information

NPI: 1003830407
Provider Name (Legal Business Name): ROBERT ROSBOROUGH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 01/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

335 FAIRVIEW ST
SILVERTON OR
97381-1916
US

IV. Provider business mailing address

335 FAIRVIEW ST
SILVERTON OR
97381-1916
US

V. Phone/Fax

Practice location:
  • Phone: 503-873-8686
  • Fax: 503-873-8689
Mailing address:
  • Phone: 503-873-8686
  • Fax: 503-873-8689

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD20022
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: