Provider Demographics
NPI:1417036963
Name:UNIVERSITY FERTILITY CONSULTANTS LLC
Entity Type:Organization
Organization Name:UNIVERSITY FERTILITY CONSULTANTS LLC
Other - Org Name:OHSU FERTILITY CONSULTANTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:UNIVERSITY PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOE
Authorized Official - Middle Name:E
Authorized Official - Last Name:ROBERTSON
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD, MBA
Authorized Official - Phone:503-494-8252
Mailing Address - Street 1:3303 SW BOND AVE.
Mailing Address - Street 2:CH 10F
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97239
Mailing Address - Country:US
Mailing Address - Phone:503-418-3712
Mailing Address - Fax:
Practice Address - Street 1:3303 SW BOND AVE.
Practice Address - Street 2:CH 10F
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239
Practice Address - Country:US
Practice Address - Phone:503-418-3712
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-03
Last Update Date:2012-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VE0102XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyReproductive EndocrinologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR287141Medicare PIN