=====================================================
General NPI Number Information
=====================================================
NPI Number | 1255804936
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | FRANCE EMILIE ROY MD, FRCPC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/06/2019
-----------------------------------------------------
Last Update Date | 01/06/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3181 SW SAM JACKSON PARK RD
-----------------------------------------------------
City | PORTLAND
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97239-3011
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 503-494-5496
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 535 NW 11TH AVE APT 1106
-----------------------------------------------------
City | PORTLAND
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97209-4067
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 418-997-0597
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207ZM0300X
-----------------------------------------------------
Taxonomy Name | Medical Microbiology Physician
-----------------------------------------------------
License Number | MD190848
-----------------------------------------------------
License Number State | OR
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207RI0200X
-----------------------------------------------------
Taxonomy Name | Infectious Disease Physician
-----------------------------------------------------
License Number | MD190848
-----------------------------------------------------
License Number State | OR
-----------------------------------------------------