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General NPI Number Information
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NPI Number | 1386739753
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Entity Type | Individual
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Provider Name | HARRIET RUSSELL STOSUR M.D.
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Gender | Female
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Dates
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Enumeration Date | 10/03/2006
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Last Update Date | 08/30/2011
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Provider Practice Location Address
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Address Line | 6600 SW 105TH AVE SUITE 205
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City | BEAVERTON
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State | OR
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Zip | 97008-8832
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Country | US
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Telephone | 503-601-3615
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Fax | 503-646-0991
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Provider Business Mailing Address
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Address Line | 6600 SW 105TH AVE SUITE 205
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City | BEAVERTON
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State | OR
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Zip | 97008-8832
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Country | US
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Telephone | 503-601-3615
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Fax | 503-646-0991
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | OR MD20612
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License Number State | OR
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