Provider Demographics
NPI:1376577940
Name:MCKIM, ROBERT MENZIE (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:MENZIE
Last Name:MCKIM
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 1:3175 POCAHONTAS RD
Mailing Address - Street 2:
Mailing Address - City:BAKER CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97814-1434
Mailing Address - Country:US
Mailing Address - Phone:541-523-4415
Mailing Address - Fax:541-523-2399
Practice Address - Street 1:3175 POCAHONTAS RD
Practice Address - Street 2:
Practice Address - City:BAKER CITY
Practice Address - State:OR
Practice Address - Zip Code:97814-1434
Practice Address - Country:US
Practice Address - Phone:541-523-4415
Practice Address - Fax:541-523-2399
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD06674207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR230847Medicaid
OR227616Medicaid
OR383846Medicare Oscar/Certification
OR08WCGBCCMedicare ID - Type UnspecifiedMEDICARE B
OR230847Medicaid