1780320382 NPI number — MITCHELL STERLING BEARD

Table of content: MITCHELL STERLING BEARD (NPI 1780320382)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780320382 NPI number — MITCHELL STERLING BEARD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BEARD
Provider First Name:
MITCHELL
Provider Middle Name:
STERLING
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
M

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:
1780320382
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/07/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1425 SW CLAY ST APT 304
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PORTLAND
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97201-6008
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
608-617-2627
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
222 SE 8TH AVE STE 212
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HILLSBORO
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97123-4218
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-352-7333
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/07/2022

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: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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