Provider Demographics
NPI:1548208929
Name:OKSENHOLT, ROBERT L (DO)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:L
Last Name:OKSENHOLT
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3489 NW HIGHWAY 101
Mailing Address - Street 2:
Mailing Address - City:LINCOLN CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97367-4959
Mailing Address - Country:US
Mailing Address - Phone:541-614-1515
Mailing Address - Fax:
Practice Address - Street 1:3489 NW HIGHWAY 101
Practice Address - Street 2:
Practice Address - City:LINCOLN CITY
Practice Address - State:OR
Practice Address - Zip Code:97367-4959
Practice Address - Country:US
Practice Address - Phone:541-614-1515
Practice Address - Fax:541-614-1516
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-04
Last Update Date:2021-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDO17321207R00000X, 207RP1001X, 207RC0200X
NY185523207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORF25485Medicare UPIN