Provider Demographics
NPI:1154485514
Name:ROBERTS, MARK N (DO)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:N
Last Name:ROBERTS
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:9340 SW BARNES RD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97225-6623
Mailing Address - Country:US
Mailing Address - Phone:503-297-6334
Mailing Address - Fax:503-297-2360
Practice Address - Street 1:10150 SE 32ND AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKIE
Practice Address - State:OR
Practice Address - Zip Code:97222-6516
Practice Address - Country:US
Practice Address - Phone:503-297-6334
Practice Address - Fax:503-297-2360
Is Sole Proprietor?:No
Enumeration Date:2006-12-20
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
ORDO18206207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR062695Medicaid
ORF79848Medicare UPIN