Provider Demographics
NPI:1114995297
Name:TANK, JULIA E (MD)
Entity Type:Individual
Prefix:
First Name:JULIA
Middle Name:E
Last Name:TANK
Suffix:
Gender:F
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:PO BOX 3808
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97208-3808
Mailing Address - Country:US
Mailing Address - Phone:503-413-3900
Mailing Address - Fax:503-413-4449
Practice Address - Street 1:1130 NW 22ND AVE STE 400
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97210-2971
Practice Address - Country:US
Practice Address - Phone:503-413-6722
Practice Address - Fax:503-413-6563
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2022-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD15729207RN0300X
WA43148207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR020979Medicaid
WA8180473Medicaid
ORF27182Medicare UPIN
OR020979Medicaid