1457423527 NPI number — DR. PATRICIA JEAN BRAZIL PH.D.

Table of content: DR. PATRICIA JEAN BRAZIL PH.D. (NPI 1457423527)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457423527 NPI number — DR. PATRICIA JEAN BRAZIL PH.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BRAZIL
Provider First Name:
PATRICIA
Provider Middle Name:
JEAN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PH.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BRAZIL
Provider Other First Name:
TRISH
Provider Other Middle Name:
J.
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
PH.D.
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1457423527
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/06/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
506 SW 6TH AVE.
Provider Second Line Business Mailing Address:
SUITE 602
Provider Business Mailing Address City Name:
PORTLAND
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97204-1526
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
503-222-5563
Provider Business Mailing Address Fax Number:
503-222-5564

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
506 SW 6TH AVE
Provider Second Line Business Practice Location Address:
SUITE 602
Provider Business Practice Location Address City Name:
PORTLAND
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97204-1533
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-222-5563
Provider Business Practice Location Address Fax Number:
503-222-5564
Provider Enumeration Date:
11/14/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103G00000X , with the licence number:  1257 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103T00000X , with the licence number: 1257 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 085287 . This is a "OMAP" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".