Provider Demographics
NPI:1336657519
Name:ROYSE, DUSTIN ROBERT (CSCS)
Entity Type:Individual
Prefix:
First Name:DUSTIN
Middle Name:ROBERT
Last Name:ROYSE
Suffix:
Gender:M
Credentials:CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1111 SW 10TH ST
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:OR
Mailing Address - Zip Code:97365-5235
Mailing Address - Country:US
Mailing Address - Phone:541-574-7301
Mailing Address - Fax:
Practice Address - Street 1:1111 SW 10TH ST
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:OR
Practice Address - Zip Code:97365-5235
Practice Address - Country:US
Practice Address - Phone:541-574-7301
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-22
Last Update Date:2018-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR7248100954246Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Other
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR7248100954OtherCSCS