Provider Demographics
NPI:1790042695
Name:ROBERT S PC
Entity Type:Organization
Organization Name:ROBERT S PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:WESLEY
Authorized Official - Last Name:SEAPY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:503-880-0612
Mailing Address - Street 1:12859 SW RIDGEFIELD LN
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97223-1767
Mailing Address - Country:US
Mailing Address - Phone:503-579-5000
Mailing Address - Fax:503-579-5001
Practice Address - Street 1:21810 WILLAMETTE DR
Practice Address - Street 2:
Practice Address - City:WEST LINN
Practice Address - State:OR
Practice Address - Zip Code:97068-3256
Practice Address - Country:US
Practice Address - Phone:503-579-5000
Practice Address - Fax:503-579-5001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-16
Last Update Date:2012-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD083382085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty