Provider Demographics
NPI:1407851363
Name:GASCH, BERNARD A (MD)
Entity Type:Individual
Prefix:DR
First Name:BERNARD
Middle Name:A
Last Name:GASCH
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 1:9427 SW BARNES RD
Mailing Address - Street 2:SUITE 495
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97225-6652
Mailing Address - Country:US
Mailing Address - Phone:503-297-3440
Mailing Address - Fax:503-297-4584
Practice Address - Street 1:9427 SW BARNES RD
Practice Address - Street 2:SUITE 495
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97225-6652
Practice Address - Country:US
Practice Address - Phone:503-297-3440
Practice Address - Fax:503-297-4584
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2008-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD24345207N00000X, 207NI0002X, 207NS0135X, 207ND0900X
WAMD00041910207NI0002X, 207NS0135X, 207ND0900X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207NI0002XAllopathic & Osteopathic PhysiciansDermatologyClinical & Laboratory Dermatological Immunology
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
No207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR232506Medicaid
OR232506Medicaid
H90394Medicare UPIN