Provider Demographics
NPI:1427243591
Name:AMON, ROBERT BICKFORD (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:BICKFORD
Last Name:AMON
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 1:1700 SW BROADWAY DR
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97201-2211
Mailing Address - Country:US
Mailing Address - Phone:503-223-4800
Mailing Address - Fax:
Practice Address - Street 1:1700 SW BROADWAY DR
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97201-2211
Practice Address - Country:US
Practice Address - Phone:503-223-4800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-11
Last Update Date:2013-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD08487207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
C92089Medicare UPIN