Provider Demographics
NPI:1295708378
Name:BROOKSHIRE, ROBERT S (PA-C)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:S
Last Name:BROOKSHIRE
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6347 NE 26TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97211-6048
Mailing Address - Country:US
Mailing Address - Phone:971-235-9779
Mailing Address - Fax:
Practice Address - Street 1:4114 MAPLE ST
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98660-1647
Practice Address - Country:US
Practice Address - Phone:360-699-8754
Practice Address - Fax:360-750-6262
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORPA00907363A00000X
WAPA10004442363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
R131271Medicare ID - Type Unspecified
Q12024Medicare UPIN