Provider Demographics
NPI:1447229323
Name:ROFFE, SHIRLEY P (MD)
Entity Type:Individual
Prefix:
First Name:SHIRLEY
Middle Name:P
Last Name:ROFFE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SHIRLEY
Other - Middle Name:ROFFE
Other - Last Name:WILLEFORD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1015 NW 22ND AVE
Mailing Address - Street 2:NORTHRUP #33
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97210-3025
Mailing Address - Country:US
Mailing Address - Phone:503-413-6384
Mailing Address - Fax:503-413-6380
Practice Address - Street 1:1015 NW 22ND AVE
Practice Address - Street 2:NORTHRUP #33
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97210-3025
Practice Address - Country:US
Practice Address - Phone:503-413-6384
Practice Address - Fax:503-413-6380
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR144052084P0800X
WA345192084P0800X
LA0173722084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR155580Medicaid
C91701Medicare UPIN
OR155580Medicaid