Basic Information
| Provider Information | |||||||||
| NPI: | 1598719221 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ALEXANDER L WOROBEY MD PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5319 SW WESTGATE DR | ||||||||
| Address2: | #241 | ||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972212432 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5032977223 | ||||||||
| FaxNumber: | 5032977603 | ||||||||
| Practice Location | |||||||||
| Address1: | 4805 NE GLISAN | ||||||||
| Address2: | |||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 97213 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5032151111 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/19/2006 | ||||||||
| LastUpdateDate: | 04/21/2008 | ||||||||
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| AuthorizedOfficialLastName: | WOROBEY | ||||||||
| AuthorizedOfficialFirstName: | ALEXANDER | ||||||||
| AuthorizedOfficialMiddleName: | L | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 5032977223 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD PC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | MD08897 | OR | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 009399000 | 01 | OR | REGENCE BCBSO | OTHER | 215046 | 05 | OR | MEDICAID |