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General NPI Number Information
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NPI Number | 1417740077
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Entity Type | Organization
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Legal Business Name | ALPENGLOW PSYCHIATRY P.C.
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Dates
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Enumeration Date | 05/27/2025
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Last Update Date | 05/27/2025
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Provider Practice Location Address
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Address Line | 5441 S MACADAM AVE # 4717
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City | PORTLAND
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State | OR
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Zip | 97239-6106
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Country | US
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Telephone | 503-926-9460
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Fax | 971-350-1563
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Provider Business Mailing Address
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Address Line | 5441 S MACADAM AVE # 4717
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City | PORTLAND
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State | OR
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Zip | 97239-6106
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Country | US
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Telephone | 503-926-9460
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Fax | 971-350-1563
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DEVRAUX R BOSHARD
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Credential | DO
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Telephone | 503-926-9460
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number |
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License Number State |
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