Provider Demographics
NPI:1922110972
Name:TARR, AUDREY ELLEN (MD)
Entity Type:Individual
Prefix:DR
First Name:AUDREY
Middle Name:ELLEN
Last Name:TARR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:AUDREY
Other - Middle Name:ELLEN
Other - Last Name:WRIGHT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1040 NW 22ND AVE, SUITE 600
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97210-3041
Mailing Address - Country:US
Mailing Address - Phone:503-413-5787
Mailing Address - Fax:503-413-5788
Practice Address - Street 1:1040 NW 22ND AVE, SUITE 600
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97210-3041
Practice Address - Country:US
Practice Address - Phone:503-413-5787
Practice Address - Fax:503-413-5788
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2019-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00040629207VF0040X
ORMD23494207VX0000X, 207VF0040X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VF0040XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyFemale Pelvic Medicine and Reconstructive Surgery
No207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics