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NPI Code Detail

MEDICARE: DR. BENNETH ANN HUSTED D.O.

MEDICARE: DR. BENNETH ANN HUSTED D.O.
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
1207QG0300XGeriatric Medicine (Family Medicine) PhysicianDO12837OR

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1067593003OTHERORBLUE CROSS BLUE SHIELD #
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1972559409
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. BENNETH ANN HUSTED D.O.
Provider Business Mailing Address
First Line : 5100 SW MACADAM AVE
Second Line : SUITE 200
City : PORTLAND
State : OR
Zip : 97239-6102
Country : US
Telephone Number : 971-202-5500
Fax Number : 971-202-5555
Provider Business Practice Location Address
First Line : 5100 SW MACADAM AVE
Second Line : SUITE 200
City : PORTLAND
State : OR
Zip : 97239-6102
Country : US
Telephone Number : 971-202-5500
Fax Number : 971-202-5555
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/26/2006
Last Update Date : 01/22/2013

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Directions to “ DR. BENNETH ANN HUSTED D.O.” Practice Location

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