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General NPI Number Information
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NPI Number | 1790885796
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Entity Type | Individual
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Provider Name | AMY S EARHART MD
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Gender | Female
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Dates
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Enumeration Date | 09/22/2006
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Last Update Date | 05/30/2025
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Provider Practice Location Address
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Address Line | 703 NE HANCOCK ST
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City | PORTLAND
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State | OR
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Zip | 97212-3955
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Country | US
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Telephone | 503-230-9875
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Fax | 503-230-9877
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Provider Business Mailing Address
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Address Line | 211 SE CARUTHERS ST
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City | PORTLAND
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State | OR
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Zip | 97214-4502
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Country | US
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Telephone | 503-224-1044
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Fax | 971-260-0355
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | MD00031951
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 207QG0300X
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Taxonomy Name | Geriatric Medicine (Family Medicine) Physician
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License Number | MD19531
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License Number State | OR
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Taxonomy #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | MD19531
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License Number State | OR
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