Provider Demographics
NPI:1760783302
Name:DIANE F. WHITNEY, M. D., P. C.
Entity Type:Organization
Organization Name:DIANE F. WHITNEY, M. D., P. C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:F
Authorized Official - Last Name:WHITNEY
Authorized Official - Suffix:
Authorized Official - Credentials:M D
Authorized Official - Phone:503-223-6360
Mailing Address - Street 1:1220 SW MORRISON ST
Mailing Address - Street 2:SUITE 525
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97205-2235
Mailing Address - Country:US
Mailing Address - Phone:503-223-6360
Mailing Address - Fax:503-497-1257
Practice Address - Street 1:1220 SW MORRISON ST
Practice Address - Street 2:SUITE 525
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97205-2235
Practice Address - Country:US
Practice Address - Phone:503-223-6360
Practice Address - Fax:503-497-1257
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-13
Last Update Date:2010-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD10974261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR0000BHKTWOtherMEDICARE ID
ORC94563Medicare UPIN