Provider Demographics
NPI:1376541995
Name:PHIPPS, RICHARD BOYD (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:BOYD
Last Name:PHIPPS
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 1:1217 NE BURNSIDE RD
Mailing Address - Street 2:SUITE 704
Mailing Address - City:GRESHAM
Mailing Address - State:OR
Mailing Address - Zip Code:97030-6722
Mailing Address - Country:US
Mailing Address - Phone:503-661-2577
Mailing Address - Fax:503-492-4546
Practice Address - Street 1:1217 NE BURNSIDE RD
Practice Address - Street 2:SUITE 704
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97030-6722
Practice Address - Country:US
Practice Address - Phone:503-661-2577
Practice Address - Fax:503-492-4546
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-08
Last Update Date:2009-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD11864207N00000X, 207ND0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORROOOOBHJTLMedicare ID - Type Unspecified
ORC3535Medicare UPIN