Bert G Tavelli
Dermatologist
2525 Nw Lovejoy St Ste 400
Portland
, Oregon 97210-2865
Bert G Tavelli
Dermatologist
2525 Nw Lovejoy St Ste 400
Portland
, Oregon 97210-2865
(503) 223-1947
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About
Features
Specialties
- Dermatologist
Languages spoken
- English
Location
First Address
- Bert G Tavelli
- 2525 Nw Lovejoy St Ste 400
- Portland, OR
- Zip : 97210-2865
- Fax : (503) 223-1947
- Phone : (503) 223-1933
Second Address
- Bert G Tavelli
- 2525 Nw Lovejoy St Ste 400
- Portland, OR
- Zip : 97210-2865
- Fax : (503) 223-1947
- Phone : (503) 223-1933
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| Y | 207N00000X | Dermatologist | MD 14681 | OR |
National Provider Identifier
| NPI | 1013918978 |
|---|---|
| Provider Name | Bert G Tavelli |
| First Address | Portland, OR 97210-2865 |
| Second Address | Portland, OR 97210-2865 |
| Gender | M |
| NPI Entity type | Individual |
| Is Sole Proprietor | No |
| Is Organization Subpart | N/A |
| Enumeration Date | 02/08/2005 |
| Last Update Date | 22/07/2021 |
Additional Identifiers
| IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
|---|---|---|
| AT2285179 | DEA (01) | |
| E84405 | (02) |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.