Provider Demographics
NPI:1629105242
Name:BUENAFE, JANICE E (MD)
Entity Type:Individual
Prefix:DR
First Name:JANICE
Middle Name:E
Last Name:BUENAFE
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 3158
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97208-3158
Mailing Address - Country:US
Mailing Address - Phone:503-215-6494
Mailing Address - Fax:503-215-6644
Practice Address - Street 1:16770 SW EDY RD
Practice Address - Street 2:SUITE 102
Practice Address - City:SHERWOOD
Practice Address - State:OR
Practice Address - Zip Code:97140-9679
Practice Address - Country:US
Practice Address - Phone:503-216-9600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2021-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV12372207Q00000X
ORMD155527207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORP01092578OtherRR MEDICARE (PH&S)-PMG
OR500641864Medicaid
ORR165568Medicare PIN
ORR165565Medicare PIN
ORR171575Medicare PIN
ORR165566Medicare PIN
ORR165569Medicare PIN
ORR168357Medicare PIN
ORR165567Medicare PIN
ORR165554Medicare PIN
ORP01092578OtherRR MEDICARE (PH&S)-PMG