Provider Demographics
NPI:1447567292
Name:PAYNE OSTERLUND, ANDREA LOUISE (DO)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:LOUISE
Last Name:PAYNE OSTERLUND
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:LOUISE
Other - Last Name:PAYNE OSTERLUND
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:9800 SE SUNNYSIDE RD
Mailing Address - Street 2:
Mailing Address - City:CLACKAMAS
Mailing Address - State:OR
Mailing Address - Zip Code:97015-9750
Mailing Address - Country:US
Mailing Address - Phone:503-813-2200
Mailing Address - Fax:
Practice Address - Street 1:9800 SE SUNNYSIDE RD
Practice Address - Street 2:
Practice Address - City:CLACKAMAS
Practice Address - State:OR
Practice Address - Zip Code:97015-9750
Practice Address - Country:US
Practice Address - Phone:503-813-2200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-31
Last Update Date:2015-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDO167439207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR390200000X.OtherPROVIDER TYPE