Provider Demographics
NPI:1942443114
Name:GINNOW, CORRIN ERIN (DO)
Entity Type:Individual
Prefix:
First Name:CORRIN
Middle Name:ERIN
Last Name:GINNOW
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:CORRIN
Other - Middle Name:ERIN
Other - Last Name:CLAYTON
Other - Suffix:
Other - Last Name Type:Former Name
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 1:10150 SE 32ND AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKIE
Practice Address - State:OR
Practice Address - Zip Code:97222-6516
Practice Address - Country:US
Practice Address - Phone:503-513-8641
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-16
Last Update Date:2021-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDO156802207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORP01133848OtherRR MEDICARE - PH&S - OREGON (PMG)
OR500647070Medicaid
OR500647070Medicaid
ORP01133848OtherRR MEDICARE - PH&S - OREGON (PMG)