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General NPI Number Information
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NPI Number | 1174708457
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Entity Type | Organization
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Legal Business Name | TANASBOURNE PLASTIC SURGERY PC
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Dates
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Enumeration Date | 01/04/2008
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Last Update Date | 05/13/2025
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Provider Practice Location Address
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Address Line | 11790 SW BARNES RD STE 120
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City | PORTLAND
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State | OR
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Zip | 97225-5938
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Country | US
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Telephone | 503-297-9340
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Fax | 503-200-5499
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Provider Business Mailing Address
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Address Line | 11790 SW BARNES RD STE 120
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City | PORTLAND
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State | OR
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Zip | 97225-5938
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Country | US
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Telephone | 503-297-9340
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Fax | 503-297-5943
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Authorized Official
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Title or Position | CLINIC ADMINISTRATOR
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Name | JANEL JAMES
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Credential |
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Telephone | 503-297-9340
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number | MD22413
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License Number State | OR
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