Provider Demographics
NPI:1730160516
Name:SAMPSON, ROBERT ALLAN (DPM)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:ALLAN
Last Name:SAMPSON
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 821350
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98682-0030
Mailing Address - Country:US
Mailing Address - Phone:503-283-5220
Mailing Address - Fax:503-283-9527
Practice Address - Street 1:5050 NE HOYT ST
Practice Address - Street 2:STE 235
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97213-2981
Practice Address - Country:US
Practice Address - Phone:503-408-1102
Practice Address - Fax:503-408-1155
Is Sole Proprietor?:No
Enumeration Date:2005-11-09
Last Update Date:2008-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDP00217213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR032511Medicaid
OR023834001OtherBLUE CROSS
OR032511Medicaid
OR023834001OtherBLUE CROSS
OR4209250001Medicare NSC