Individual
ANDREW BLAUVELT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
9495 SW LOCUST STREET, SUITE A, PORTLAND, OR 97223-6683
(503) 445-2200
Mailing address
9495 SW LOCUST STREET, SUITE A, PORTLAND, OR 97223-6683
(503) 445-2204
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
MD24935
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
274963
—
OR
Enumeration date
08/01/2006
Last updated
08/15/2011
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