Healthcare Provider Details

I. General information

NPI: 1023010428
Provider Name (Legal Business Name): RICHARD J BARSOTTI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2005
Last Update Date: 03/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9300 SE 91ST AVE STE 200
HAPPY VALLEY OR
97086-3762
US

IV. Provider business mailing address

15455 NW GREENBRIER PKWY STE 112
BEAVERTON OR
97006-7374
US

V. Phone/Fax

Practice location:
  • Phone: 503-261-1171
  • Fax: 503-253-5989
Mailing address:
  • Phone: 503-466-1668
  • Fax: 503-439-6194

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD13024
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: