Provider Demographics
NPI:1104872233
Name:DINE, DAVID ELLIOTT (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:ELLIOTT
Last Name:DINE
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 1:9427 SW BARNES RD
Mailing Address - Street 2:SUITE 595
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97225-6652
Mailing Address - Country:US
Mailing Address - Phone:503-297-6976
Mailing Address - Fax:503-297-7004
Practice Address - Street 1:9427 SW BARNES RD
Practice Address - Street 2:SUITE 595
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97225-6652
Practice Address - Country:US
Practice Address - Phone:503-297-6976
Practice Address - Fax:503-297-7004
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD097572084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR262410Medicaid
C92520Medicare UPIN
0000BHWBZMedicare ID - Type Unspecified