MEDICARE: JUDITH A NIGRO DO

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	207R00000X	Internal Medicine Physician	DO25918	OR
2	207RC0000X	Cardiovascular Disease Physician	DO25918	OR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1760566368
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUDITH A NIGRO DO

Provider Business Mailing Address
First Line	:	24900 SE STARK ST
Second Line	:	STE. 103
City	:	GRESHAM
State	:	OR
Zip	:	97030-3355
Country	:	US
Telephone Number	:	503-907-1101
Fax Number	:	503-907-0177

Provider Business Practice Location Address
First Line	:	1200 NW NAITO PKWY
Second Line	:	STE. 200
City	:	PORTLAND
State	:	OR
Zip	:	97209-2830
Country	:	US
Telephone Number	:	503-943-2340
Fax Number	:	503-248-4733

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

Provider Enumeration Date	:	10/24/2006
Last Update Date	:	07/27/2022

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Directions to “ JUDITH A NIGRO DO” Practice Location

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