Provider Demographics
NPI:1013178797
Name:BAILEY, AMANDA K BLOCKINGER (MD)
Entity Type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:K BLOCKINGER
Last Name:BAILEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:AMANDA
Other - Middle Name:KATHRYN
Other - Last Name:BLOCKINGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:6234 N GREELEY AVE
Mailing Address - Street 2:SELLWOOD MEDICAL CLINIC
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97217-5020
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6234 N GREELEY AVE
Practice Address - Street 2:SELLWOOD MEDICAL CLINIC
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97217-5020
Practice Address - Country:US
Practice Address - Phone:503-595-9300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-24
Last Update Date:2016-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD 60018395208000000X
ORMD28515208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics