1386739753 NPI number — DR. HARRIET RUSSELL STOSUR M.D.

Table of content: DR. HARRIET RUSSELL STOSUR M.D. (NPI 1386739753)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386739753 NPI number — DR. HARRIET RUSSELL STOSUR M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STOSUR
Provider First Name:
HARRIET
Provider Middle Name:
RUSSELL
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1386739753
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/30/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6600 SW 105TH AVE
Provider Second Line Business Mailing Address:
SUITE 205
Provider Business Mailing Address City Name:
BEAVERTON
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97008-8832
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
503-601-3615
Provider Business Mailing Address Fax Number:
503-646-0991

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6600 SW 105TH AVE
Provider Second Line Business Practice Location Address:
SUITE 205
Provider Business Practice Location Address City Name:
BEAVERTON
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97008-8832
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-601-3615
Provider Business Practice Location Address Fax Number:
503-646-0991
Provider Enumeration Date:
10/03/2006

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: 207V00000X , with the licence number:  OR MD20612 , 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)





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