Provider Demographics
NPI:1841286366
Name:CHESTLER, ROBERT J (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:J
Last Name:CHESTLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10502 NE WASCO ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97220-3948
Mailing Address - Country:US
Mailing Address - Phone:503-252-2467
Mailing Address - Fax:503-252-0670
Practice Address - Street 1:10502 NE WASCO ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97220-3948
Practice Address - Country:US
Practice Address - Phone:503-252-2467
Practice Address - Fax:503-252-0670
Is Sole Proprietor?:No
Enumeration Date:2005-09-20
Last Update Date:2009-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR16214207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR13545Medicaid
WCJRZBMedicare ID - Type Unspecified
ORE28574Medicare UPIN