Mangrum, Robert Dylan

Mangrum, Robert Dylan is an individual health care provider with primary practice located at 3181 Sw Sam Jackson Park Rd , Portland OR 97239-3011. He recently has 2 registered licenses in different health care specialties including Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant, Physician Assistants & Advanced Practice Nursing Providers / Surgical. Physician Assistants & Advanced Practice Nursing Providers / Surgical is his primary health care specialty. Mangrum, Robert Dylan can be contacted via phone (503) 494-8311.

Contact Information

Primary practice address
3181 Sw Sam Jackson Park Rd Portland OR 97239-3011
Phone: (503) 494-8311
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X PA9101478 Florida
Physician Assistants & Advanced Practice Nursing Providers / Surgical 363AS0400X PA172009 Oregon

Profile Details

NPI number 1871546838
LBN Legal business name Mangrum, Robert Dylan
Credentials Physician's Assistant Certified (PA-C)
Entity Individual
Sole proprietor 1 No
Enumeration date May 18th, 2006
Last updated Nov 16th, 2023 - about 2 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1871546838 NPPES
Florida Other 1497748743 GROUP NPI NUMBER / LRHSI
Florida MEDICAID 292286000 GROUP NPI NUMBER / LRHSI
Florida Other DA5786 GROUP NPI NUMBER / LRHSI
Florida MEDICAID 500692609 GROUP NPI NUMBER / LRHSI

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