Provider Demographics
NPI:1255581625
Name:ROSE CITY WOMEN'S HEALTH, P.C.
Entity type:Organization
Organization Name:ROSE CITY WOMEN'S HEALTH, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:DRAKE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:503-215-2100
Mailing Address - Street 1:507 NE 47TH AVE STE 204
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97213-2245
Mailing Address - Country:US
Mailing Address - Phone:503-215-2100
Mailing Address - Fax:
Practice Address - Street 1:507 NE 47TH AVE STE 204
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97213-2245
Practice Address - Country:US
Practice Address - Phone:503-215-2100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-23
Last Update Date:2012-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR145047OtherMEDICARE PTAN
OR500603643Medicaid