Provider Demographics
NPI:1942203534
Name:SEGAL, GERALD MARC (MD)
Entity Type:Individual
Prefix:DR
First Name:GERALD
Middle Name:MARC
Last Name:SEGAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:265 N BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97227-1800
Mailing Address - Country:US
Mailing Address - Phone:503-280-1223
Mailing Address - Fax:503-528-5252
Practice Address - Street 1:265 N BROADWAY ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97227-1800
Practice Address - Country:US
Practice Address - Phone:503-280-1223
Practice Address - Fax:503-528-5252
Is Sole Proprietor?:No
Enumeration Date:2005-05-27
Last Update Date:2012-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD14774207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR171454Medicaid
WA1022695Medicaid
OR105530Medicare PIN
OR171454Medicaid
WAG8888713Medicare PIN