Provider Demographics
NPI:1033227574
Name:ESPARZA, BRIAN P (MD)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:P
Last Name:ESPARZA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1135 SE SALMON ST STE 101
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97214-2695
Mailing Address - Country:US
Mailing Address - Phone:503-573-8388
Mailing Address - Fax:503-206-8106
Practice Address - Street 1:1135 SE SALMON ST STE 101
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97214-2695
Practice Address - Country:US
Practice Address - Phone:503-573-8388
Practice Address - Fax:503-206-8106
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-25
Last Update Date:2019-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD000456592084P0800X
ORMD274622084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR274318Medicaid
ORR137757Medicare PIN