Provider Demographics
NPI:1174642367
Name:RATH, ROBERT STUART (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:STUART
Last Name:RATH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14125 SW FARMINGTON RD
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97005-2567
Mailing Address - Country:US
Mailing Address - Phone:503-643-2000
Mailing Address - Fax:503-641-9284
Practice Address - Street 1:14125 SW FARMINGTON RD
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97005-2567
Practice Address - Country:US
Practice Address - Phone:503-643-2000
Practice Address - Fax:503-641-9284
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD12626207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR22647-2Medicaid
C93582Medicare UPIN
OR22647-2Medicaid