Provider Demographics
NPI:1124199484
Name:PHOEBE RICH, MD LLC
Entity Type:Organization
Organization Name:PHOEBE RICH, MD LLC
Other - Org Name:OREGON DERMATOLOGY AND RESEARCH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PHOEBE
Authorized Official - Middle Name:
Authorized Official - Last Name:RICH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:503-226-3376
Mailing Address - Street 1:2565 NW LOVEJOY ST STE 200
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97210-2996
Mailing Address - Country:US
Mailing Address - Phone:503-226-3376
Mailing Address - Fax:503-223-9561
Practice Address - Street 1:2565 NW LOVEJOY ST STE 200
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97210-2996
Practice Address - Country:US
Practice Address - Phone:503-226-3376
Practice Address - Fax:503-223-9561
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-10
Last Update Date:2008-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD14488174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR115977Medicare PIN
ORE79229Medicare UPIN