Provider Demographics
NPI:1598739385
Name:DILLON, DEBRA CAROLYN (MD)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:CAROLYN
Last Name:DILLON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:DEBORAH
Other - Middle Name:CAROLYN
Other - Last Name:BIRCHER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:847 NE 19TH AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97232-2684
Mailing Address - Country:US
Mailing Address - Phone:503-963-2801
Mailing Address - Fax:503-963-2825
Practice Address - Street 1:501 N GRAHAM ST
Practice Address - Street 2:SUITE 445
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97227-1654
Practice Address - Country:US
Practice Address - Phone:503-284-5220
Practice Address - Fax:503-284-4971
Is Sole Proprietor?:No
Enumeration Date:2006-02-16
Last Update Date:2014-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD24197207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0198210OtherLABOR & INDUSTRIES
WA8435570Medicaid
WA8854830Medicare ID - Type Unspecified
WA8435570Medicaid
WA0198210OtherLABOR & INDUSTRIES
OR137771Medicare UPIN