Provider Demographics
NPI:1922384569
Name:BELOOF, GRANT LA BARRE (MD)
Entity Type:Individual
Prefix:DR
First Name:GRANT
Middle Name:LA BARRE
Last Name:BELOOF
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2456 NW NORTHRUP ST
Mailing Address - Street 2:SUITE 1A
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97210-3253
Mailing Address - Country:US
Mailing Address - Phone:503-708-8292
Mailing Address - Fax:503-222-1686
Practice Address - Street 1:2456 NW NORTHRUP ST
Practice Address - Street 2:SUITE 1A
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97210-3253
Practice Address - Country:US
Practice Address - Phone:503-708-8292
Practice Address - Fax:503-222-1686
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-27
Last Update Date:2014-12-17
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Provider Licenses
StateLicense IDTaxonomies
ORMD1624152084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry