Healthcare Provider Details

I. General information

NPI: 1790885796
Provider Name (Legal Business Name): AMY S EARHART MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2006
Last Update Date: 05/30/2025
Certification Date: 05/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

703 NE HANCOCK ST
PORTLAND OR
97212-3955
US

IV. Provider business mailing address

211 SE CARUTHERS ST
PORTLAND OR
97214-4502
US

V. Phone/Fax

Practice location:
  • Phone: 503-230-9875
  • Fax: 503-230-9877
Mailing address:
  • Phone: 503-224-1044
  • Fax: 971-260-0355

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD00031951
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License NumberMD19531
License Number StateOR
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD19531
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: