Provider Demographics
NPI:1235371485
Name:FRANK S. ROSENBLOOM, M.D. PC
Entity type:Organization
Organization Name:FRANK S. ROSENBLOOM, M.D. PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSENBLOOM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:503-692-5250
Mailing Address - Street 1:6464 SW BORLAND RD
Mailing Address - Street 2:SUITE B2
Mailing Address - City:TUALATIN
Mailing Address - State:OR
Mailing Address - Zip Code:97062-8876
Mailing Address - Country:US
Mailing Address - Phone:503-692-5250
Mailing Address - Fax:
Practice Address - Street 1:6464 SW BORLAND RD
Practice Address - Street 2:SUITE B2
Practice Address - City:TUALATIN
Practice Address - State:OR
Practice Address - Zip Code:97062-8876
Practice Address - Country:US
Practice Address - Phone:503-692-5250
Practice Address - Fax:503-612-0573
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-02
Last Update Date:2009-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD20064207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR079496Medicaid
OR079496Medicaid