MEDICARE: DIANE ROMAYNE BAKER MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207N00000X	Dermatology Physician	MD08916	OR

General Provider Information

NPI Number	:	1083613913
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIANE ROMAYNE BAKER MD

Provider Business Mailing Address
First Line	:	9495 SW LOCUST ST STE A&E
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97223-6683
Country	:	US
Telephone Number	:	503-471-0500
Fax Number	:	503-471-0504

Provider Business Practice Location Address
First Line	:	9495 SW LOCUST ST STE A&E
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97223-6683
Country	:	US
Telephone Number	:	503-471-0500
Fax Number	:	503-471-0504

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/21/2005
Last Update Date	:	07/29/2015

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