Provider Demographics
NPI:1083859235
Name:ROBERT F BURCH PHD PC
Entity Type:Organization
Organization Name:ROBERT F BURCH PHD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:F
Authorized Official - Last Name:BURCH PHD PC
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:541-388-9271
Mailing Address - Street 1:PO BOX 13101
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97213-0101
Mailing Address - Country:US
Mailing Address - Phone:503-528-8404
Mailing Address - Fax:503-528-8405
Practice Address - Street 1:390 SW COLUMBIA ST STE 210
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97702-3227
Practice Address - Country:US
Practice Address - Phone:541-388-9271
Practice Address - Fax:541-388-0479
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-02
Last Update Date:2009-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1710103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR140294Medicare PIN