Roger A Wicklund, M.D.

Primary specialty

Urology PhysicianTaxonomy code 208800000X

License

MD09630 Issued in OR

Practice address

9135 SW Barnes Rd
Ste. 663
Portland, OR 97225-6646

Phone

(503) 297-1078

Fax

(503) 292-2176

NPI assigned

Aug 27, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1156636800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1350345600000",
    "number": "1417065848",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9135 SW BARNES RD",
            "address_2": "STE. 663",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972256646",
            "telephone_number": "503-297-1078",
            "fax_number": "503-292-2176"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9135 SW BARNES RD",
            "address_2": "STE. 663",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972256646",
            "telephone_number": "503-297-1078",
            "fax_number": "503-292-2176"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WICKLUND",
        "first_name": "ROGER",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-27",
        "last_updated": "2012-10-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "OR",
            "license": "MD09630",
            "primary": true
        },
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "WA",
            "license": "MD00034648",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Shelby Wick
• Carey Wickham
• Michelle Antoinette Wickliff, T/CHW,DOULA,CRM,HCW
• Laura Marie Wickline, PMHNP
• Natalie Rose Wickline, DDS
• Jacob Wicks
• Melody Ann Wickstrom
• Edward Wickwire, LMT
• Chelsey Ann Widby
• Dawn Widener

• Urology Physician in Portland, OR
• Providers in Portland, OR by specialty
• Urology Physician in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 16, 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.

Verify at the official NPI Registry.