Provider Demographics
NPI:1922174127
Name:BARICH, FRANK CHARLES (MD PHD)
Entity Type:Individual
Prefix:MR
First Name:FRANK
Middle Name:CHARLES
Last Name:BARICH
Suffix:
Gender:M
Credentials:MD PHD
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:
Mailing Address - Fax:
Practice Address - Street 1:15640 NW LAIDLAW RD
Practice Address - Street 2:SUITE 102
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97229-3828
Practice Address - Country:US
Practice Address - Phone:503-764-0100
Practice Address - Fax:503-764-0166
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2021-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD23297207R00000X
261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
3002523842OtherBLUE CROSS
OR227001Medicaid
ORR153547Medicare PIN
ORR153546Medicare PIN
ORR168298Medicare PIN
H86044Medicare ID - Type Unspecified
OR227001Medicaid