Provider Demographics
NPI:1841203700
Name:FIELDS, ROBERT DWAIN (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:DWAIN
Last Name:FIELDS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1341 NW BENFIELD DR
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97229-9151
Mailing Address - Country:US
Mailing Address - Phone:503-292-2977
Mailing Address - Fax:503-292-3034
Practice Address - Street 1:730 SE OAK ST
Practice Address - Street 2:SUITE D
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97123-4245
Practice Address - Country:US
Practice Address - Phone:503-640-3724
Practice Address - Fax:503-648-8982
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR08275207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR00WFBXJAMedicare ID - Type Unspecified
ORC92616Medicare UPIN