Standage, Blayne A

Standage, Blayne A is an individual health care provider with primary practice located at 1130 Nw 22Nd Ave Suite300, Portland OR 97210-2900. He recently has only one registered license in Allopathic & Osteopathic Physicians / Surgery, which is considered as his primary health care specialty. Standage, Blayne A can be contacted via phone (503) 226-4325.

Contact Information

Primary practice address
1130 Nw 22Nd Ave Suite300 Portland OR 97210-2900
Phone: (503) 226-4325
Fax: (503) 227-5024
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Surgery 208600000X MD12970 Oregon

Profile Details

NPI number 1164410874
LBN Legal business name Standage, Blayne A
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Oct 7th, 2005
Last updated Mar 4th, 2011 - about 15 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1164410874 NPPES
Other MD12970 STATE LICENSE
MEDICAID 161513 STATE LICENSE

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