MEDICARE: RODERICK P. CALKINS PHD

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
1	103T00000X	Psychologist	0867	OR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1497818777
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RODERICK P. CALKINS PHD

Provider Business Mailing Address
First Line	:	2154 NE BROADWAY ST STE 110
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97232-1561
Country	:	US
Telephone Number	:	503-320-3059
Fax Number	:

Provider Business Practice Location Address
First Line	:	2154 NE BROADWAY ST STE 110
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97232-1561
Country	:	US
Telephone Number	:	503-320-3059
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/18/2006
Last Update Date	:	07/09/2007

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Directions to “ RODERICK P. CALKINS PHD” Practice Location

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