Provider Demographics
NPI:1730898610
Name:NASH, ROBERT LEROY
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:LEROY
Last Name:NASH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:534 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-7118
Mailing Address - Country:US
Mailing Address - Phone:540-200-1530
Mailing Address - Fax:541-772-0284
Practice Address - Street 1:534 E MAIN ST
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-7118
Practice Address - Country:US
Practice Address - Phone:541-200-1530
Practice Address - Fax:541-772-0284
Is Sole Proprietor?:No
Enumeration Date:2022-11-18
Last Update Date:2022-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR500196061207QA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine