Individual
TRACY BAZAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
5050 NE HOYT ST STE 315, PORTLAND, OR 97213-2982
(503) 215-8580
Mailing address
PO BOX 3158, PORTLAND, OR 97208-3158
(503) 215-6494
Taxonomy
Speciality
Code
Description
License number
State
2084N0008X
Neuromuscular Medicine (Psychiatry & Neurology) Physician
Primary
MD187129
OR
2084N0400X
Neurology Physician
MD187129
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500672696
—
OR
Enumeration date
04/15/2014
Last updated
11/25/2022
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