Provider Demographics
NPI:1275799082
Name:ABBOTT, ROXANA RUTH MASSEY (DO)
Entity Type:Individual
Prefix:DR
First Name:ROXANA
Middle Name:RUTH MASSEY
Last Name:ABBOTT
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:ROXANA
Other - Middle Name:RUTH
Other - Last Name:MASSEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:PO BOX 3158
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97208-3158
Mailing Address - Country:US
Mailing Address - Phone:503-215-6494
Mailing Address - Fax:503-215-6644
Practice Address - Street 1:15640 NW LAIDLAW RD
Practice Address - Street 2:SUITE 102
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97229-3828
Practice Address - Country:US
Practice Address - Phone:503-764-0100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-31
Last Update Date:2012-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOL60018342207Q00000X
ORDO155981207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORP01026743OtherRR MEDICARE
OR500638687Medicaid
ORR161234Medicare PIN