Healthcare Provider Details

I. General information

NPI: 1659574648
Provider Name (Legal Business Name): AMY DOSS BEDNAR M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2007
Last Update Date: 01/04/2022
Certification Date: 07/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 N GRAHAM ST SUITE 100
PORTLAND OR
97227-1683
US

IV. Provider business mailing address

12200 RENFERT WAY STE G-3
AUSTIN TX
78758-5654
US

V. Phone/Fax

Practice location:
  • Phone: 503-413-1122
  • Fax: 503-413-4238
Mailing address:
  • Phone: 512-821-2540
  • Fax: 512-776-1956

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number153872
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License Number153872
License Number StateOR
# 3
Primary TaxonomyY
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License NumberS9849
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: