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NPI Code Detail

MEDICARE: DR. WARREN SCOTT TUBBS MD

MEDICARE: DR. WARREN SCOTT TUBBS 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
12085R0202XDiagnostic Radiology PhysicianMD19579OR

General Provider Information

NPI Number : 1962518662
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. WARREN SCOTT TUBBS MD
Provider Business Mailing Address
First Line : 233 NE 102ND AVE
Second Line :
City : PORTLAND
State : OR
Zip : 97220-4106
Country : US
Telephone Number : 503-253-1105
Fax Number : 503-535-8398
Provider Business Practice Location Address
First Line : 233 NE 102ND AVE
Second Line :
City : PORTLAND
State : OR
Zip : 97220-4106
Country : US
Telephone Number : 503-253-1105
Fax Number : 503-535-8398
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/22/2006
Last Update Date : 07/08/2007

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