DR. BRUCE C DOUGLAS (NPI# 1134158561) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1134158561 |
| Entity Type | Individual |
| Full Name | DR. BRUCE C DOUGLAS |
| Credential | M.D. |
| Practice Address |
10803 Se Cherry Blossom Dr Portland OR 97216-3107 |
| Practice Telephone | 5032617200 |
| Practice Fax Number | 5032617249 |
| Mailing Telephone | 5032617200 |
| Mailing Fax Number | 5032617249 |
| Enumeration Date | 2006-06-30 |
| Last Update Date | 2007-07-08 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Q00000X | Family Medicine | MD14055 | OR | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| OR | 220673 | 05 | |
| OR | PACIFICARE | 430120810002 | 01 |
| OR | BC/BS | 003350005 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1811250459 | Bruce Graham Douglas | Nurse Practitioner | 400 El Camino Dr, #210, Cypress Gardens, FL 33884-1697 | 2012-06-19 |
| 1417978842 | Bruce R Douglas | Physician Assistant | 103 Camelia St., Royal City, WA 99357 | 2006-07-21 |
| 1023233558 | Bruce Douglas | Occupational Therapist | 4319 Church Ave, Brooklyn, NY 11203-3101 | 2007-04-17 |
| 1013006444 | Bruce Palmer Douglas | Spec/Tech, Pathology | 100 Albright Way Ste C, Los Gatos, CA 95032-1837 | 2006-10-12 |
| 1568448553 | Bruce R. Douglas | Radiology | 200 1st St Sw, Rochester, MN 55905-0001 | 2005-12-21 |
| 1891776670 | Bruce Lee Douglas | Dentist | 701 14th St, North Chicago, IL 60064-1409 | 2005-11-09 |
| Street Address |
10803 SE CHERRY BLOSSOM DR |
| City | PORTLAND |
| State | OR |
| Zip Code | 97216-3107 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1649215922 | David Rae Blessing | Family Medicine | 10803 Se Cherry Blossom Dr, Portland, OR 97216-3107 | 2006-06-19 |
| 1598364689 | Zednia Carolina Linares | Dietitian, Registered | 10803 Se Cherry Blossom Dr, Portland, OR 97216-3107 | 2020-10-20 |
| 1982238069 | Leanne Michelle Witek | Dietitian, Registered | 10803 Se Cherry Blossom Dr, Portland, OR 97216-3107 | 2020-02-27 |
| 1225508369 | Valeria Mallett Nutrition LLC | Dietitian, Registered | 10803 Se Cherry Blossom Dr, Portland, OR 97216-3107 | 2018-12-02 |
| 1639697709 | Haley Brooke Moak | Physician Assistant | 10803 Se Cherry Blossom Dr, Portland, OR 97216-3107 | 2017-09-08 |
| 1285168435 | Valeria Mallett | Dietitian, Registered | 10803 Se Cherry Blossom Dr, Portland, OR 97216-3107 | 2017-04-14 |
| 1417223629 | Megan Huang | Dietitian, Registered | 10803 Se Cherry Blossom Dr, Portland, OR 97216-3107 | 2012-04-02 |
| 1457645368 | Nathaneal Bruce Douglas | Family Medicine | 10803 Se Cherry Blossom Dr, Portland, OR 97216-3107 | 2011-06-08 |
| 1417265075 | Alexandra Conner | Physician Assistant | 10803 Se Cherry Blossom Dr, Portland, OR 97216-3107 | 2010-09-16 |
| 1053630756 | Joshua M Reese | Family Medicine | 10803 Se Cherry Blossom Dr, Portland, OR 97216-3107 | 2010-05-20 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1316468341 | Accident Care Chiropractic and Massage of Salem | Clinic/Center | 2168 Lancaster Dr. Ne, Portland, OR 97216 | 2017-06-29 |
| 1528508520 | Damone Brown | Peer Specialist | 10209 Se Washington St, Suite D, Portland, OR 97216 | 2017-02-24 |
| 1861937237 | Malachai Investments LLC | Clinical Medical Laboratory | 10,000 Se Main St, Ste 360, Portland, OR 97216 | 2016-12-21 |
| 1881136836 | Krista Marie Darnell | Occupational Therapy Assistant | 1475, Se 100th Avenue, Portland, OR 97216 | 2016-11-08 |
| 1821456559 | Sean Kelly | Counselor | 10564 Se Washington Street, Portland, OR 97216 | 2016-02-09 |
| 1174908321 | Phil Bergland | Counselor | 11220 Se Stark St, Suite 6, Portland, OR 97216 | 2015-07-29 |
| 1134507346 | Beth Lopez | Massage Therapist | 5814 Se Stark Street, Portland, OR 97216 | 2015-05-08 |
| 1982081477 | Amelia C Hunt | Counselor | 10564 Se Washinton Street, Portland, OR 97216 | 2015-05-04 |
| 1073907978 | Karen Ta | Emergency Medicine | 10300 Se Main St, Portland, OR 97216 | 2015-03-27 |
| 1265823298 | Laura Catherine Anderson | Occupational Therapist | 1475 Se 100th Avenue, Portland, OR 97216 | 2015-02-12 |
| Find all providers in zip 97216 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1639710783 | Christine Elizabeth O'connor | Family Medicine | 6336 Se 61st Ave, Portland, OR 97206-6718 | 2019-09-30 |
| 1427608645 | Carehere LLC | Family Medicine | Carehere Clinic- Nasg Portland, Tn, 160 Kirby Drive, Portland, TN 37148 | 2019-09-19 |
| 1063064285 | Victoria A Deane | Family Medicine | 37 Fall Brook St, Portland, ME 04103-4224 | 2019-07-09 |
| 1598238214 | Whole Systems Healthcare | Family Medicine | 1020 Sw Taylor St Ste 340, Portland, OR 97205-2508 | 2019-01-04 |
| 1770089245 | Richard Farwell Leman | Family Medicine | 800 Ne Oregon St., Suite 772, Portland, OR 97232 | 2018-04-03 |
| 1952803413 | Aleksandra Giedowyn Md PC | Family Medicine | 1923 Ne Broadway Street Suite 2, Portland, OR 97232 | 2018-03-01 |
| 1871943159 | Micah Kiehl | Family Medicine | 4427 Ne Fremont St, Portland, OR 97213-1153 | 2016-06-16 |
| 1083068589 | Carrie Lynn Binder | Family Medicine | 1035 Nw Northrup St, Portland, OR 97209-3017 | 2016-04-20 |
| 1437513835 | Kayce A Spear | Family Medicine | 10803 Se Cherry Blossom Drive, Portland, OR 97216-3107 | 2016-04-12 |
| 1992175509 | Lone Star Evaluations Inc. | Family Medicine | 1500 Wildcat Dr Ste M, Portland, TX 78374-2826 | 2015-09-25 |
| Find all providers in PORTLAND | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.