Petzold, Robert W.

Petzold, Robert W. is an individual health care provider with primary practice located at 500 5Th St , Brookings OR 97415-9702. He recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as his primary health care specialty. Petzold, Robert W. can be contacted via phone (541) 412-2000.

Contact Information

Primary practice address
500 5Th St Brookings OR 97415-9702
Phone: (541) 412-2000
Fax: (541) 469-2081
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X MD24244 Oregon

Profile Details

NPI number 1649495490
LBN Legal business name Petzold, Robert W.
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Apr 16th, 2007
Last updated Feb 13th, 2014 - about 11 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 1649495490 NPPES
Oregon MEDICAID 231907

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