Provider Demographics
NPI:1568497832
Name:MT. HOOD EAR, NOSE & THROAT PC
Entity Type:Organization
Organization Name:MT. HOOD EAR, NOSE & THROAT PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:DARRYK
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:BARLOW
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:503-257-3204
Mailing Address - Street 1:10202 E BURNSIDE ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97216-2732
Mailing Address - Country:US
Mailing Address - Phone:503-257-3204
Mailing Address - Fax:503-255-7208
Practice Address - Street 1:10202 E BURNSIDE ST
Practice Address - Street 2:SUITE 1
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97216-2732
Practice Address - Country:US
Practice Address - Phone:503-257-3204
Practice Address - Fax:503-255-7208
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-12
Last Update Date:2015-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR241870Medicaid
OR138091Medicare PIN
OR241870Medicaid
A45555Medicare UPIN