Basic Information
Provider Information | |||||||||
NPI: | 1891937686 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | PAGE | ||||||||
FirstName: | ROBERT | ||||||||
MiddleName: | R | ||||||||
NamePrefix: | MR. | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 8800 SE SUNNYSIDE RD STE 300N | ||||||||
Address2: |   | ||||||||
City: | CLACKAMAS | ||||||||
State: | OR | ||||||||
PostalCode: | 970155703 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2812862999 | ||||||||
FaxNumber: | 5126074893 | ||||||||
Practice Location | |||||||||
Address1: | 1369 S MAIN ST STE 106 | ||||||||
Address2: |   | ||||||||
City: | BOERNE | ||||||||
State: | TX | ||||||||
PostalCode: | 780062860 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8302495844 | ||||||||
FaxNumber: | 8302498898 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 03/25/2009 | ||||||||
LastUpdateDate: | 03/17/2018 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | Y | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 237600000X |   | TX | N |   | Speech, Language and Hearing Service Providers | Audiologist-Hearing Aid Fitter |   | 237700000X | 80308 | TX | Y |   | Speech, Language and Hearing Service Providers | Hearing Instrument Specialist |   |
No ID Information.