MEDICARE: DR. JOHN OAKLEY BEAHRS M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084F0202X	Forensic Psychiatry Physician	MD 12489	OR
2	2084P0800X	Psychiatry Physician	MD 12489	OR
3	2084P0800X	Psychiatry Physician	G50296	CA
4	2084F0202X	Forensic Psychiatry Physician	G50296	CA
5	2084P0800X	Psychiatry Physician	MD 00012038	WA
6	2084F0202X	Forensic Psychiatry Physician	MD 00012038	WA

General Provider Information

NPI Number	:	1558359687
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN OAKLEY BEAHRS M.D.

Provider Business Mailing Address
First Line	:	3006 NE BRYCE ST
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97212-1718
Country	:	US
Telephone Number	:	503-287-3448
Fax Number	:	503-335-8444

Provider Business Practice Location Address
First Line	:	3006 NE BRYCE ST
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97212-1718
Country	:	US
Telephone Number	:	503-287-3448
Fax Number	:	503-335-8444

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/12/2005
Last Update Date	:	11/19/2008

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