Individual
AZADEH REZVAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
10100 SE SUNNYSIDE RD, MT TALERT MEDICAL OFFICE, DIVISION OF UROGYNECOLOGY, CLACKAMAS, OR 97015-8970
(503) 652-2880
Mailing address
10100 SE SUNNYSIDE RD. MT TALBERT MEDICAL OFFICE,, DEPARTMENT OF OB/GYN, DIVISION OF UROGYNECOLOGY, CLACKAMAS, OR 97015
(503) 652-2880
Taxonomy
Speciality
Code
Description
License number
State
207VF0040X
Urogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
Primary
MD171989
OR
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
08/06/2008
Last updated
08/25/2015
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