# ROBERTS STREET CLINIC, P.C.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1003024423
- **Authorized official:** LINDA MANKEY (CLINIC MANAGER)
- **Authorized official phone:** (503) 669-3066

## Contact information

- **Practice address:** 400 NE ROBERTS AVE, GRESHAM, OR 97030-7464
- **Practice address phone:** (503) 669-3066
- **Practice address fax:** (503) 665-6404
- **Mailing address:** 400 NE ROBERTS AVE, GRESHAM, OR 97030-7464
- **Mailing address phone:** (503) 669-3066
- **Mailing address fax:** (503) 665-6404

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | DO15150 | OR | — |
| 207Q00000X | Family Medicine Physician | DO18839 | OR | Yes |
| 207Q00000X | Family Medicine Physician | DO21884 | OR | — |
| 207R00000X | Internal Medicine Physician | MD17149 | OR | — |

## Other

- **Enumeration date:** 05/18/2007
- **Last updated:** 10/10/2007