Individual
DR. NICHOLAS PETROCHKO JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
9900 SE SUNNYSIDE RD, CLACKAMAS, OR 97015-9777
(503) 652-2880
(503) 571-8984
Mailing address
9900 SE SUNNYSIDE RD, CLACKAMAS, OR 97015-9777
(503) 652-2880
(503) 571-8984
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
MD010073
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2000698
BLUE CROSS OF TENNESSEE
TN
05
—
3013285
—
TN
01
—
4535569
AETNA
TN
Enumeration date
08/11/2006
Last updated
02/20/2008
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