Individual
CHARISSA ROSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
9205 SW BARNES RD, SUITE 5E, PORTLAND, OR 97225-6603
(503) 216-2028
Mailing address
PO BOX 3158, PORTLAND, OR 97208-3158
(503) 215-6494
(503) 215-6644
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
MD23235
OR
2084P0800X
Psychiatry Physician
Primary
MD23235
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
287087
—
OR
05
—
500626951
—
OR
01
—
P00838383
RR MEDICARE
OR
Enumeration date
07/12/2006
Last updated
10/05/2020
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