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NPI Code Detail

MEDICARE: DR. ORA NAOMI BOTWINICK MD

MEDICARE: DR. ORA NAOMI BOTWINICK 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
1207Q00000XFamily Medicine PhysicianMD17563OR

General Provider Information

NPI Number : 1093866634
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ORA NAOMI BOTWINICK MD
Provider Business Mailing Address
First Line : 421 SW OAK ST
Second Line : 210
City : PORTLAND
State : OR
Zip : 97204-1817
Country : US
Telephone Number : 503-988-3674
Fax Number : 503-988-5305
Provider Business Practice Location Address
First Line : 9000 N LOMBARD ST
Second Line :
City : PORTLAND
State : OR
Zip : 97203-3006
Country : US
Telephone Number :
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/12/2007
Last Update Date : 04/18/2019

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