MEDICARE: ANDREW BLAUVELT MD

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	207N00000X	Dermatology Physician	MD24935	OR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1932115425
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREW BLAUVELT MD

Provider Business Mailing Address
First Line	:	9495 SW LOCUST STREET
Second Line	:	SUITE A
City	:	PORTLAND
State	:	OR
Zip	:	97223-6683
Country	:	US
Telephone Number	:	503-445-2204
Fax Number	:

Provider Business Practice Location Address
First Line	:	9495 SW LOCUST STREET
Second Line	:	SUITE A
City	:	PORTLAND
State	:	OR
Zip	:	97223-6683
Country	:	US
Telephone Number	:	503-445-2200
Fax Number	:

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

Provider Enumeration Date	:	08/01/2006
Last Update Date	:	08/15/2011

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