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General NPI Number Information
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NPI Number | 1790042695
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Entity Type | Organization
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Legal Business Name | ROBERT S PC
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Dates
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Enumeration Date | 04/16/2012
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Last Update Date | 04/16/2012
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Provider Practice Location Address
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Address Line | 21810 WILLAMETTE DR
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City | WEST LINN
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State | OR
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Zip | 97068-3256
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Country | US
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Telephone | 503-579-5000
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Fax | 503-579-5001
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Provider Business Mailing Address
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Address Line | 12859 SW RIDGEFIELD LN
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City | PORTLAND
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State | OR
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Zip | 97223-1767
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Country | US
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Telephone | 503-579-5000
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Fax | 503-579-5001
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Authorized Official
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Title or Position | OWNER
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Name | DR. ROBERT WESLEY SEAPY
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Credential | MD
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Telephone | 503-880-0612
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | MD08338
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License Number State | OR
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