Provider Demographics
NPI:1871877506
Name:BELICH, ROBERTA G (PA-C)
Entity type:Individual
Prefix:MS
First Name:ROBERTA
Middle Name:G
Last Name:BELICH
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:ROBERTA
Other - Middle Name:L
Other - Last Name:GARVEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:2500 NE NEFF RD
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-6015
Mailing Address - Country:US
Mailing Address - Phone:541-382-4321
Mailing Address - Fax:
Practice Address - Street 1:384 SE COMBS FLAT RD STE 1200
Practice Address - Street 2:
Practice Address - City:PRINEVILLE
Practice Address - State:OR
Practice Address - Zip Code:97754-2562
Practice Address - Country:US
Practice Address - Phone:541-447-6263
Practice Address - Fax:541-447-8724
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-29
Last Update Date:2022-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA54007207Q00000X
363AM0700X
ORPA156554363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical