Provider Demographics
NPI:1174613608
Name:GORSUCH, ROBERT AUSTIN (DO)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:AUSTIN
Last Name:GORSUCH
Suffix:
Gender:M
Credentials:DO
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1034
Mailing Address - Street 2:MAIL CODE V3GP3
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97207-1034
Mailing Address - Country:US
Mailing Address - Phone:503-220-8262
Mailing Address - Fax:360-905-1733
Practice Address - Street 1:1601 E FOURTH PLAIN BLVD
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98661-3753
Practice Address - Country:US
Practice Address - Phone:503-220-8262
Practice Address - Fax:360-905-1733
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
ORDO14735207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine