Basic Information
| Provider Information | |||||||||
| NPI: | 1437241601 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BITTS | ||||||||
| FirstName: | LAURA | ||||||||
| MiddleName: | KAY | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6640 SW REDWOOD LANE | ||||||||
| Address2: | |||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 97224 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5036207358 | ||||||||
| FaxNumber: | 5036246144 | ||||||||
| Practice Location | |||||||||
| Address1: | 6640 SW REDWOOD LANE | ||||||||
| Address2: | |||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 97224 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5036207358 | ||||||||
| FaxNumber: | 5036246144 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/28/2006 | ||||||||
| LastUpdateDate: | 11/06/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/06/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | MD24318 | OR | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 227374 | 05 | OR | MEDICAID |