Provider Demographics
NPI:1043324213
Name:HOLEVA, JUDITH ROBIN (DO)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:ROBIN
Last Name:HOLEVA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2800 SW 257TH AVE
Mailing Address - Street 2:
Mailing Address - City:TROUTDALE
Mailing Address - State:OR
Mailing Address - Zip Code:97060-1803
Mailing Address - Country:US
Mailing Address - Phone:503-667-7711
Mailing Address - Fax:503-669-9908
Practice Address - Street 1:5536 SE WOODSTOCK BLVD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97206-6829
Practice Address - Country:US
Practice Address - Phone:503-236-1830
Practice Address - Fax:503-236-1908
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDO19080207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
080136513OtherRAILROAD MEDICARE
OR151059Medicaid
OR151059Medicaid
G43732Medicare UPIN