Provider Demographics
NPI:1962411470
Name:PIEPENBRINK, ROGER A (DO MPH FACP FACE)
Entity type:Individual
Prefix:
First Name:ROGER
Middle Name:A
Last Name:PIEPENBRINK
Suffix:
Gender:M
Credentials:DO MPH FACP FACE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2120
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97208-2120
Mailing Address - Country:US
Mailing Address - Phone:541-274-6556
Mailing Address - Fax:541-274-6247
Practice Address - Street 1:2821 DAGGETT AVE STE 200
Practice Address - Street 2:
Practice Address - City:KLAMATH FALLS
Practice Address - State:OR
Practice Address - Zip Code:97601-1130
Practice Address - Country:US
Practice Address - Phone:541-274-8400
Practice Address - Fax:541-274-8405
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2021-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1653641207R00000X
ORDO192691207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism