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NPI Code Detail

MEDICARE: ROBERT PARK MD

MEDICARE: ROBERT PARK MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207V00000XObstetrics & Gynecology PhysicianMD26448OR

General Provider Information

NPI Number : 1083617633
Entity Type Code : Individual
Provider Name (Legal Business Name) : ROBERT PARK MD
Provider Business Mailing Address
First Line : 2111 EXCHANGE ST
Second Line :
City : ASTORIA
State : OR
Zip : 97103-3329
Country : US
Telephone Number : 503-325-4321
Fax Number :
Provider Business Practice Location Address
First Line : 2265 EXCHANGE ST
Second Line :
City : ASTORIA
State : OR
Zip : 97103-3331
Country : US
Telephone Number : 503-338-7595
Fax Number : 503-325-4905
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/27/2005
Last Update Date : 02/10/2022

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Directions to “ ROBERT PARK MD” Practice Location

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