Provider Demographics
NPI:1760566368
Name:NIGRO, JUDITH A (DO)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:A
Last Name:NIGRO
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:24900 SE STARK ST
Mailing Address - Street 2:STE. 103
Mailing Address - City:GRESHAM
Mailing Address - State:OR
Mailing Address - Zip Code:97030-3355
Mailing Address - Country:US
Mailing Address - Phone:503-907-1101
Mailing Address - Fax:503-907-0177
Practice Address - Street 1:1200 NW NAITO PKWY
Practice Address - Street 2:STE. 200
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97209-2830
Practice Address - Country:US
Practice Address - Phone:503-943-2340
Practice Address - Fax:503-248-4733
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2022-07-27
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Provider Licenses
StateLicense IDTaxonomies
ORDO25918207R00000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR240379Medicaid
WAG8919064Medicare PIN
OR240379Medicaid