Provider Demographics
NPI:1326021916
Name:TAITANO, ANTHONY M (MD)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:M
Last Name:TAITANO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6932 SW WINDEMERE LOOP
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97225-6163
Mailing Address - Country:US
Mailing Address - Phone:503-297-5418
Mailing Address - Fax:
Practice Address - Street 1:6932 SW WINDEMERE LOOP
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97225-6163
Practice Address - Country:US
Practice Address - Phone:503-297-5418
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-28
Last Update Date:2014-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD 11911207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR228031Medicaid
ORF 03377Medicare UPIN
OR106587Medicare ID - Type Unspecified