Healthcare Provider Details

I. General information

NPI: 1467945006
Provider Name (Legal Business Name): REBECCA ANN ANTHONY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2018
Last Update Date: 10/27/2023
Certification Date: 10/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5228 NE HOYT ST BLDG B3
PORTLAND OR
97213-3055
US

IV. Provider business mailing address

PO BOX 3158
PORTLAND OR
97208-3158
US

V. Phone/Fax

Practice location:
  • Phone: 503-215-4860
  • Fax: 971-282-0091
Mailing address:
  • Phone: 503-215-6494
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD210671
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: