Provider Demographics
NPI:1619904158
Name:DRONKOWSKI, CARL WILLIAM (MD)
Entity Type:Individual
Prefix:
First Name:CARL
Middle Name:WILLIAM
Last Name:DRONKOWSKI
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 1:1600 NE COMPTON DR STE 210
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97006-6988
Mailing Address - Country:US
Mailing Address - Phone:503-648-9565
Mailing Address - Fax:503-648-1282
Practice Address - Street 1:12670 NW BARNES RD STE 100
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97229-9001
Practice Address - Country:US
Practice Address - Phone:503-648-9565
Practice Address - Fax:503-648-1282
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD12788207R00000X, 207RH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8454571Medicaid
OR26310Medicaid
C92539Medicare UPIN
WA8868353Medicare PIN
OR26310Medicaid