Individual
BLAYNE A STANDAGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1130 NW 22ND AVE, SUITE300, PORTLAND, OR 97210-2900
(503) 226-4325
(503) 227-5024
Mailing address
1130 NW 22ND AVE, SUITE300, PORTLAND, OR 97210-2900
(503) 226-4325
(503) 227-5024
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
MD12970
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
161513
—
OR
01
—
MD12970
STATE LICENSE
—
Enumeration date
10/07/2005
Last updated
03/04/2011
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