Provider Demographics
NPI:1467439158
Name:BALEN, ROBERT FRANCIS (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:FRANCIS
Last Name:BALEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:ROBERT
Other - Middle Name:FRANCIS
Other - Last Name:SCHICHTEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:18160 GREENBLUFF DR
Mailing Address - Street 2:
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97034-6419
Mailing Address - Country:US
Mailing Address - Phone:503-636-9715
Mailing Address - Fax:
Practice Address - Street 1:10502 NE WASCO ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97220-3948
Practice Address - Country:US
Practice Address - Phone:503-252-2467
Practice Address - Fax:503-252-0670
Is Sole Proprietor?:No
Enumeration Date:2005-12-23
Last Update Date:2009-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR07448207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR237941Medicaid
114145Medicare ID - Type Unspecified
C91027Medicare UPIN