Individual
BRONWYN BAZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
10180 SE SUNNYSIDE RD, CLACKAMAS, OR 97015-8970
(503) 652-2880
Mailing address
10180 SE SUNNYSIDE RD, CLACKAMAS, OR 97015-8970
(503) 652-2880
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
A96638
CA
208000000X
Pediatrics Physician
Primary
MD28390
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00A966380
—
CA
01
—
MD28390
OREGON MEDICAL LICENSE
OR
Enumeration date
05/01/2007
Last updated
08/06/2008
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