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NPI Code Detail

MEDICARE: DR. ROBERT CONOVER MACAULEY JR. M.D.

MEDICARE: DR. ROBERT CONOVER MACAULEY JR. M.D.
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
1208000000XPediatrics Physician0420010479VT
22080H0002XPediatric Hospice and Palliative Medicine Physician182551OR

General Provider Information

NPI Number : 1881746899
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ROBERT CONOVER MACAULEY JR. M.D.
Provider Business Mailing Address
First Line : 3181 SW SAM JACKSON PARK RD
Second Line :
City : PORTLAND
State : OR
Zip : 97239-3011
Country : US
Telephone Number : 503-494-8417
Fax Number : 503-494-4455
Provider Business Practice Location Address
First Line : 3181 SW SAM JACKSON PARK RD
Second Line :
City : PORTLAND
State : OR
Zip : 97239-3011
Country : US
Telephone Number : 503-494-8417
Fax Number : 503-494-4455
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/18/2007
Last Update Date : 07/21/2022

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