Provider Demographics
NPI:1992790687
Name:EPSTEIN, ROGER JAY (MD)
Entity type:Individual
Prefix:DR
First Name:ROGER
Middle Name:JAY
Last Name:EPSTEIN
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 1:693 GLATT CIR
Mailing Address - Street 2:
Mailing Address - City:WOODBURN
Mailing Address - State:OR
Mailing Address - Zip Code:97071-9600
Mailing Address - Country:US
Mailing Address - Phone:503-873-8740
Mailing Address - Fax:503-982-4898
Practice Address - Street 1:693 GLATT CIR
Practice Address - Street 2:
Practice Address - City:WOODBURN
Practice Address - State:OR
Practice Address - Zip Code:97071-9600
Practice Address - Country:US
Practice Address - Phone:503-873-8740
Practice Address - Fax:503-982-4898
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-19
Last Update Date:2007-07-08
Deactivation Date:2006-03-23
Deactivation Code:
Reactivation Date:2006-04-03
Provider Licenses
StateLicense IDTaxonomies
ORMD23973207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR286475Medicaid
ORB98970Medicare UPIN
ORR113461Medicare ID - Type Unspecified