Robert W. Petzold, M.D.
Individual provider Active NPI Family Medicine Physician · Brookings, OR
NPI 1649495490 · NPPES record last updated Feb 13, 2014
Key facts
- NPI
- 1649495490
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- MD24244 (OR)
- Practice address
- 500 5TH St
Brookings, OR 97415-9702 - Phone
- (541) 412-2000
- Fax
- (541) 469-2081
- NPI assigned
- Apr 16, 2007
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MD24244 | OR | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Alder Medical Center PC | Family Medicine | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | MD24244 | OR | Yes |
Addresses
Primary practice location
500 5TH St
Brookings, OR 97415-9702
Mailing address
94220 4TH St
Gold Beach, OR 97444-7756
Phone (541) 247-3000
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 231907 | Medicaid | OR |
Other providers in Brookings, OR
- Wayne Robert Paulson
- William Payne
- Kristine M Perrotti Floyd
- Jan Perrotti
- Julie Catherine Peterson
- Nicole Pezzullo
- Sandra Phillips
- Nancy Diane Porter
- Thomas L Poulton
- Precision Eyecare P.C.
All providers in Brookings, OR · Family Medicine Physician in Oregon
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 13, 2014. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.