Provider Demographics
NPI:1497765499
Name:CHAPMAN, CAROLYN NOBUKO (MD)
Entity Type:Individual
Prefix:DR
First Name:CAROLYN
Middle Name:NOBUKO
Last Name:CHAPMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:10200 SW EASTRIDGE ST
Mailing Address - Street 2:SUITE 205
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97225-5064
Mailing Address - Country:US
Mailing Address - Phone:503-280-4555
Mailing Address - Fax:503-280-4559
Practice Address - Street 1:10200 SW EASTRIDGE ST
Practice Address - Street 2:SUITE 205
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97225-5064
Practice Address - Country:US
Practice Address - Phone:503-280-4555
Practice Address - Fax:503-280-4559
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2014-10-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ORMD27539207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORF42470Medicare UPIN
ORR167116Medicare PIN