Provider Demographics
NPI:1942552062
Name:RICHARD S POLIN PC
Entity Type:Organization
Organization Name:RICHARD S POLIN PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:SANDERS
Authorized Official - Last Name:POLIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:503-666-8149
Mailing Address - Street 1:PO BOX 25714
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97298-0714
Mailing Address - Country:US
Mailing Address - Phone:503-666-8139
Mailing Address - Fax:503-666-3434
Practice Address - Street 1:24900 SE STARK ST
Practice Address - Street 2:SUITE 208
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97030-3355
Practice Address - Country:US
Practice Address - Phone:503-666-8139
Practice Address - Fax:503-666-3434
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-12
Last Update Date:2012-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD 25930207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR1043373996OtherINDIVIDUAL NPI