Provider Demographics
NPI:1538114988
Name:DEMLOW, ANITA JOY (MD)
Entity Type:Individual
Prefix:
First Name:ANITA
Middle Name:JOY
Last Name:DEMLOW
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:PO BOX 4825
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97208-4825
Mailing Address - Country:US
Mailing Address - Phone:360-397-4040
Mailing Address - Fax:360-604-1770
Practice Address - Street 1:700 NE 87TH AVE STE 110
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98664-1913
Practice Address - Country:US
Practice Address - Phone:360-882-2778
Practice Address - Fax:360-604-1761
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2019-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD17263207P00000X
WAMD00035734207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1012694Medicaid
ORF51633Medicare UPIN
OR054929Medicaid