Provider Demographics
NPI:1851472047
Name:ROBERT VON BORSTEL II, MD, PC
Entity Type:Organization
Organization Name:ROBERT VON BORSTEL II, MD, 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:C
Authorized Official - Last Name:VON BORSTEL
Authorized Official - Suffix:II
Authorized Official - Credentials:MD
Authorized Official - Phone:503-292-6238
Mailing Address - Street 1:3439 NE SANDY BLVD
Mailing Address - Street 2:PMB 375
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97232-1959
Mailing Address - Country:US
Mailing Address - Phone:503-284-8841
Mailing Address - Fax:503-282-3302
Practice Address - Street 1:9450 SW BARNES RD
Practice Address - Street 2:STE 230
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97225-6619
Practice Address - Country:US
Practice Address - Phone:503-292-6238
Practice Address - Fax:503-292-9680
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2007-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD220782084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR130305Medicaid
OR130305Medicaid
ORH27827Medicare UPIN