Individual
ROBERT W.T. MYALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3181 SW SAM JACKSON PARK RD, PORTLAND, OR 97239-3011
(503) 494-8914
Mailing address
8229 SW 11TH AVE, PORTLAND, OR 97219-4311
Taxonomy
Speciality
Code
Description
License number
State
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
DF0014
OR
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
Primary
MD23291
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
287170
—
OR
Enumeration date
07/31/2006
Last updated
07/08/2007
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