Provider Demographics
NPI:1417178641
Name:ROBERTS, WARREN G (MD)
Entity type:Individual
Prefix:DR
First Name:WARREN
Middle Name:G
Last Name:ROBERTS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6464 SW BORLAND ROAD
Mailing Address - Street 2:SUITE A-2
Mailing Address - City:TUALATIN
Mailing Address - State:OR
Mailing Address - Zip Code:97062
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6485 SW BORLAND RD
Practice Address - Street 2:SUITE G
Practice Address - City:TUALATIN
Practice Address - State:OR
Practice Address - Zip Code:97062-9762
Practice Address - Country:US
Practice Address - Phone:503-691-9380
Practice Address - Fax:503-691-9381
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2017-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO45973207T00000X
ORMD153449208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice