Provider Demographics
NPI:1518978717
Name:LIND, RENAE L (MD)
Entity Type:Individual
Prefix:
First Name:RENAE
Middle Name:L
Last Name:LIND
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 1:1040 NW 22ND AVE
Mailing Address - Street 2:STE330
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97210-3057
Mailing Address - Country:US
Mailing Address - Phone:503-274-9936
Mailing Address - Fax:503-274-2660
Practice Address - Street 1:1040 NW 22ND AVE
Practice Address - Street 2:STE330
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97210-3057
Practice Address - Country:US
Practice Address - Phone:503-274-9936
Practice Address - Fax:503-274-2660
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2013-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD15760207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR024658Medicaid
OR024658Medicaid
OR109580Medicare ID - Type Unspecified