Healthcare Provider Details

I. General information

NPI: 1861794414
Provider Name (Legal Business Name): AMIRA BAKER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMIRA BAKER-JUD

II. Dates (important events)

Enumeration Date: 12/01/2010
Last Update Date: 09/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

707 SW GAINES ST
PORTLAND OR
97239
US

IV. Provider business mailing address

707 SW GAINES ST
PORTLAND OR
97239-2901
US

V. Phone/Fax

Practice location:
  • Phone: 503-813-2000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA114518
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2080P0208X
TaxonomyPediatric Infectious Diseases Physician
License NumberA114518
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code2080P0208X
TaxonomyPediatric Infectious Diseases Physician
License Number60829920
License Number StateWA
# 4
Primary TaxonomyY
Taxonomy Code2080P0208X
TaxonomyPediatric Infectious Diseases Physician
License NumberMD186820
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: