Provider Demographics
NPI:1437385994
Name:DE LATORRE, BARBARA (MD)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:
Last Name:DE LATORRE
Suffix:
Gender:F
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: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 1:16180 SE SUNNYSIDE RD
Practice Address - Street 2:STE 102
Practice Address - City:CLACKAMAS
Practice Address - State:OR
Practice Address - Zip Code:97015-6302
Practice Address - Country:US
Practice Address - Phone:503-513-8930
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-10
Last Update Date:2012-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD29214207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500634333Medicaid
ORR162455Medicare PIN
OR500634333Medicaid
ORR164256Medicare PIN
ORR164254Medicare PIN
ORR164258Medicare PIN
ORR164259Medicare PIN