Provider Demographics
NPI:1306976022
Name:ROBERSON, FRANK CLIFFORD (MD)
Entity type:Individual
Prefix:DR
First Name:FRANK
Middle Name:CLIFFORD
Last Name:ROBERSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:F.
Other - Middle Name:CLIFFORD
Other - Last Name:ROBERSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:3615 NW SAMARITAN DR
Mailing Address - Street 2:SUITE 210
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97330-3783
Mailing Address - Country:US
Mailing Address - Phone:541-768-5210
Mailing Address - Fax:541-768-5211
Practice Address - Street 1:3615 NW SAMARITAN DR
Practice Address - Street 2:SUITE 210
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97330-3783
Practice Address - Country:US
Practice Address - Phone:541-768-5210
Practice Address - Fax:541-768-5211
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD11838207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR227410Medicaid
OR227410Medicaid
OR130043Medicare ID - Type Unspecified