Healthcare Provider Details

I. General information

NPI: 1316050503
Provider Name (Legal Business Name): BRIAN J GEHRING MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2006
Last Update Date: 07/10/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3500 N INTERSTATE AVE
PORTLAND OR
97227-1196
US

IV. Provider business mailing address

3500 N INTERSTATE AVE
PORTLAND OR
97227-1196
US

V. Phone/Fax

Practice location:
  • Phone: 503-285-9321
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberMD14025
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberMD00029404
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberG67966
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: