Provider Demographics
NPI:1609847722
Name:OKASINSKI, ROBERT E (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:E
Last Name:OKASINSKI
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 1:700 D ST
Mailing Address - Street 2:
Mailing Address - City:ELKTON
Mailing Address - State:OR
Mailing Address - Zip Code:97436-7513
Mailing Address - Country:US
Mailing Address - Phone:419-239-3345
Mailing Address - Fax:
Practice Address - Street 1:2700 NW STEWART PKWY
Practice Address - Street 2:
Practice Address - City:ROSEBURG
Practice Address - State:OR
Practice Address - Zip Code:97471-1281
Practice Address - Country:US
Practice Address - Phone:541-673-0611
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-27
Last Update Date:2014-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-046219207P00000X
ORMD150279207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0543844Medicaid
OR500615583Medicaid
WA1609847722Medicaid
OHOK4261922Medicare PIN
WAG8891035Medicare PIN
OHA83103Medicare UPIN
OH0543844Medicaid
OH0619405Medicare PIN
P00350740Medicare PIN