Active NPI
Robert Poe
- Clinical Psychologist
- Portland, OR
National Provider Identifier
1063768893
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 2223
- Practice address
- 1133 NW 21St Ave
Suite 204
Portland, OR 97209-1513 - Phone
- (503) 957-2497
- NPI assigned
- Jul 30, 2012
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 2223 | OR | Primary |
Addresses
Primary practice location
1133 NW 21St Ave
Suite 204
Portland, OR 97209-1513
Mailing address
PO Box 96036
Portland, OR 97296-6000
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2223 | OR | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1343606400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1343606400000",
"number": "1063768893",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 96036",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972966000"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1133 NW 21ST AVE",
"address_2": "SUITE 204",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972091513",
"telephone_number": "503-957-2497"
}
],
"practiceLocations": [],
"basic": {
"last_name": "POE",
"first_name": "ROBERT",
"name_prefix": "Dr.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2012-07-30",
"last_updated": "2012-07-30",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "OR",
"license": "2223",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Portland, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 30, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.