Provider Demographics
NPI:1639312820
Name:BARON, ROSE (MD)
Entity Type:Individual
Prefix:
First Name:ROSE
Middle Name:
Last Name:BARON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ROZALIYA
Other - Middle Name:
Other - Last Name:BARON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:4926 SW CORBETT AVE APT 401
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97239-3931
Mailing Address - Country:US
Mailing Address - Phone:310-867-1690
Mailing Address - Fax:
Practice Address - Street 1:3181 SW SAM JACKSON PARK RD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239-3011
Practice Address - Country:US
Practice Address - Phone:503-494-7680
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-17
Last Update Date:2013-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD162837207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine