Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | DO26816 | OR |
Y | 111NI0900X | Internist | DO26816 | OR |
NPI | 1003019340 |
---|---|
Provider Name | Evagelia Baros |
First Address | Portland, OR 97208-3158 |
Second Address | Tigard, OR 97223-3396 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/06/2007 |
Last Update Date | 02/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
006209 | (05) | OR |
P00604907 | RR MEDICARE - PROVIDENCE (01) | OR |