Individual
ROBERT MAYER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
AGPCNP
Contact information
Practice address
440 NW DIVISION ST, GRESHAM, OR 97030-5506
(503) 215-9500
Mailing address
PO BOX 3158, PORTLAND, OR 97208-3158
Taxonomy
Speciality
Code
Description
License number
State
363LG0600X
Gerontology Nurse Practitioner
Primary
201504149NP-PP
OR
363LP2300X
Primary Care Nurse Practitioner
201504149NP-PP
OR
363LP2300X
Primary Care Nurse Practitioner
RN2275111
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500690883
—
OR
Enumeration date
08/08/2013
Last updated
01/05/2016
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