Healthcare Provider Details

I. General information

NPI: 1588655708
Provider Name (Legal Business Name): ROBERT D HEROS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/04/2005
Last Update Date: 04/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6464 SW BORLAND RD SUITE C-1
TUALATIN OR
97062-9999
US

IV. Provider business mailing address

6464 SW BORLAND RD SUITE C-1
TUALATIN OR
97062-9999
US

V. Phone/Fax

Practice location:
  • Phone: 503-885-1515
  • Fax: 503-885-1520
Mailing address:
  • Phone: 503-885-1515
  • Fax: 503-885-1520

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License NumberMD27619
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: