Provider Demographics
NPI:1205818101
Name:RICH, PHOEBE (MD)
Entity Type:Individual
Prefix:DR
First Name:PHOEBE
Middle Name:
Last Name:RICH
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 1:2565 NW LOVEJOY ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97210-2846
Mailing Address - Country:US
Mailing Address - Phone:503-226-3376
Mailing Address - Fax:503-224-9903
Practice Address - Street 1:2565 NW LOVEJOY ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97210-2846
Practice Address - Country:US
Practice Address - Phone:503-226-3376
Practice Address - Fax:503-224-9903
Is Sole Proprietor?:No
Enumeration Date:2005-11-16
Last Update Date:2009-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD14488174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR115977Medicare ID - Type UnspecifiedGROUP