Provider Demographics
NPI:1235103987
Name:FARRELL, LORI J (MD)
Entity Type:Individual
Prefix:DR
First Name:LORI
Middle Name:J
Last Name:FARRELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 N GRAHAM ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97227-1683
Mailing Address - Country:US
Mailing Address - Phone:503-413-4134
Mailing Address - Fax:503-413-1895
Practice Address - Street 1:300 N GRAHAM ST
Practice Address - Street 2:SUITE 200
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97227-1683
Practice Address - Country:US
Practice Address - Phone:503-413-4134
Practice Address - Fax:503-413-1895
Is Sole Proprietor?:No
Enumeration Date:2006-02-16
Last Update Date:2011-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD23636207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR286731Medicaid
OR286731Medicaid
H58300Medicare UPIN