Individual
ROBERT W. PETZOLD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
500 5TH ST, BROOKINGS, OR 97415-9702
(541) 412-2000
(541) 469-2081
Mailing address
94220 4TH ST, GOLD BEACH, OR 97444-7756
(541) 247-3000
(541) 247-3151
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD24244
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
231907
—
OR
Enumeration date
04/16/2007
Last updated
02/13/2014
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