MEDICARE: CARLA CHRISTINE RADCLIFFE 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	207Q00000X	Family Medicine Physician	MD22700	OR

General Provider Information

NPI Number	:	1811038193
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARLA CHRISTINE RADCLIFFE MD

Provider Business Mailing Address
First Line	:	421 SW OAK ST
Second Line	:	STE 210
City	:	PORTLAND
State	:	OR
Zip	:	97204-1817
Country	:	US
Telephone Number	:	503-988-7468
Fax Number	:	503-988-3015

Provider Business Practice Location Address
First Line	:	6736 NE KILLINGSWORTH ST
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97218-3338
Country	:	US
Telephone Number	:	503-988-3601
Fax Number	:	503-988-3998

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

Provider Enumeration Date	:	02/09/2007
Last Update Date	:	06/17/2014

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