Healthcare Provider Details

I. General information

NPI: 1093038614
Provider Name (Legal Business Name): MARGARET ALLISON BAYNHAM MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARGARET ALLISON MOORMAN

II. Dates (important events)

Enumeration Date: 03/10/2010
Last Update Date: 08/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7213 SW HAZELFERN RD
TIGARD OR
97224-9722
US

IV. Provider business mailing address

7213 SW HAZEL FERN ROAD
TIGARD OR
97224
US

V. Phone/Fax

Practice location:
  • Phone: 503-214-2064
  • Fax: 503-598-3600
Mailing address:
  • Phone: 503-214-2064
  • Fax: 503-598-3600

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD161650
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier500657444
Identifier TypeMEDICAID
Identifier StateOR
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: