Christina Bellmore
Individual provider Active NPI Specialist · Gresham, OR
NPI 1639727795 · NPPES record last updated Aug 30, 2019
Key facts
- NPI
- 1639727795
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Specialist 174400000X
- License
- 22376 (OR)
- Practice address
- 1748 NW Fairview Dr # a
Gresham, OR 97030-3842 - Phone
- (503) 492-3910
- NPI assigned
- Aug 30, 2019
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 22376 | OR | MD | Specialist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | 22376 | OR | Yes |
Addresses
Primary practice location
1748 NW Fairview Dr # a
Gresham, OR 97030-3842
Mailing address
1748 NW Fairview Dr # a
Gresham, OR 97030-3842
Phone (503) 492-3910
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 22376 | Other | OR | LMT |
Other providers in Gresham, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 30, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.