Provider Demographics
NPI:1780818278
Name:ACKER, ROBERT LEROY (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:LEROY
Last Name:ACKER
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 1:18475 NE SMITH RD
Mailing Address - Street 2:
Mailing Address - City:NEWBERG
Mailing Address - State:OR
Mailing Address - Zip Code:97132-9300
Mailing Address - Country:US
Mailing Address - Phone:503-807-7073
Mailing Address - Fax:503-625-8512
Practice Address - Street 1:18475 NE SMITH RD
Practice Address - Street 2:
Practice Address - City:NEWBERG
Practice Address - State:OR
Practice Address - Zip Code:97132-9300
Practice Address - Country:US
Practice Address - Phone:503-807-7073
Practice Address - Fax:503-625-8512
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-12
Last Update Date:2009-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD07272207Q00000X, 2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery