Healthcare Provider Details

I. General information

NPI: 1093967770
Provider Name (Legal Business Name): EDWARD BIRNBAUM RRT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/14/2008
Last Update Date: 10/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9800 SE SUNNYSIDE RD
CLACKAMAS OR
97015-9750
US

IV. Provider business mailing address

9800 SE SUNNYSIDE RD
CLACKAMAS OR
97015
US

V. Phone/Fax

Practice location:
  • Phone: 503-571-4772
  • Fax: 503-571-5653
Mailing address:
  • Phone: 503-571-4775
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2279G1100X
TaxonomyGeneral Care Registered Respiratory Therapist
License NumberRT-P-000199
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: