Individual
BROOKS ROBERT GASTON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
9000 N LOMBARD ST, PORTLAND, OR 97203-3006
(503) 988-5304
(503) 988-5305
Mailing address
421 SW OAK ST, STE. 210, PORTLAND, OR 97204-1817
(503) 988-3663
(503) 988-3015
Taxonomy
Speciality
Code
Description
License number
State
163WC1500X
Community Health Registered Nurse
201150091NP
OR
363L00000X
Nurse Practitioner
Primary
201150091NP
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
22959
—
OR
Enumeration date
01/14/2011
Last updated
01/14/2013
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