Provider Demographics
NPI:1578612354
Name:LAHM, BRIDGET (PAC)
Entity Type:Individual
Prefix:
First Name:BRIDGET
Middle Name:
Last Name:LAHM
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10305 SW PARK WAY STE 300
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97225-5033
Mailing Address - Country:US
Mailing Address - Phone:503-295-0730
Mailing Address - Fax:503-295-0731
Practice Address - Street 1:10305 SW PARK WAY STE 300
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97225-5033
Practice Address - Country:US
Practice Address - Phone:503-295-0730
Practice Address - Fax:503-295-0731
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORPA00969363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORQ21002Medicare UPIN
OR119713Medicare UPIN