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Individual

BLAKE CARTER OSMUNDSEN

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
5050 NE HOYT ST, SUITE 615, PORTLAND, OR 97213-2991
(503) 231-0407
(503) 231-0484
Mailing address
5050 NE HOYT ST, SUITE 615, PORTLAND, OR 97213-2991
(503) 231-0407
(503) 231-0484

Taxonomy

Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
MD17368
OR
207VF0040X
Urogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
Primary
MD17368
OR
207VG0400X
Gynecology Physician
MD00044007
WA
207VG0400X
Gynecology Physician
MD17368
OR

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
028386
OR
Enumeration date
05/08/2006
Last updated
02/13/2019
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