Provider Demographics
NPI:1518146984
Name:CAIN, PATRICIA EILEEN (DPM)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:EILEEN
Last Name:CAIN
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1510 DIVISION ST
Mailing Address - Street 2:SUITE 80
Mailing Address - City:OREGON CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97045-1581
Mailing Address - Country:US
Mailing Address - Phone:503-655-0775
Mailing Address - Fax:503-655-0751
Practice Address - Street 1:1510 DIVISION ST
Practice Address - Street 2:SUITE 80
Practice Address - City:OREGON CITY
Practice Address - State:OR
Practice Address - Zip Code:97045-1581
Practice Address - Country:US
Practice Address - Phone:503-655-0775
Practice Address - Fax:503-655-0751
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-01
Last Update Date:2007-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDP00269213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR158763Medicaid
OR158763Medicaid