=====================================================
General NPI Number Information
=====================================================
NPI Number | 1497868145
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MICHAEL JOHN BARRETT M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/16/2006
-----------------------------------------------------
Last Update Date | 10/27/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9735 SW SHADY LN STE 102
-----------------------------------------------------
City | TIGARD
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97223-5481
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 503-620-5614
-----------------------------------------------------
Fax | 503-598-4688
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9735 SW SHADY LN STE 102
-----------------------------------------------------
City | TIGARD
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97223-5481
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 503-620-5614
-----------------------------------------------------
Fax | 503-598-4688
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207K00000X
-----------------------------------------------------
Taxonomy Name | Allergy & Immunology Physician
-----------------------------------------------------
License Number | OR MD16160
-----------------------------------------------------
License Number State | OR
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207K00000X
-----------------------------------------------------
Taxonomy Name | Allergy & Immunology Physician
-----------------------------------------------------
License Number | WA MD00027120
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------