Individual
CAROL G STULL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
9555 SW BARNES RD, SUITE 100, PORTLAND, OR 97225-6663
(503) 292-3577
(503) 292-3947
Mailing address
7650 SW BEVELAND RD, SUITE 200, PORTLAND, OR 97223-8692
(503) 292-3577
(503) 292-3947
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
MD 21384
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
151223
—
OR
01
—
R106586
MEDICARE PTAN
OR
Enumeration date
11/28/2005
Last updated
06/24/2016
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