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Organization
ROBERTS STREET CLINIC, P.C.
Active
Organization
ROBERTS STREET CLINIC, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LINDA MANKEY (CLINIC MANAGER)
(503) 669-3066
Entity
Organization
Contact information
Practice address
400 NE ROBERTS AVE, GRESHAM, OR 97030-7464
(503) 669-3066
(503) 665-6404
Mailing address
400 NE ROBERTS AVE, GRESHAM, OR 97030-7464
(503) 669-3066
(503) 665-6404
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
DO15150
OR
207Q00000X
Family Medicine Physician
Primary
DO18839
OR
207Q00000X
Family Medicine Physician
DO21884
OR
207R00000X
Internal Medicine Physician
MD17149
OR
Other
Enumeration date
05/18/2007
Last updated
10/10/2007
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