Basic Information
| Provider Information | |||||||||
| NPI: | 1497868145 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BARRETT | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | JOHN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9735 SW SHADY LN | ||||||||
| Address2: | STE 102 | ||||||||
| City: | TIGARD | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972235481 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5036205614 | ||||||||
| FaxNumber: | 5035984688 | ||||||||
| Practice Location | |||||||||
| Address1: | 9735 SW SHADY LN | ||||||||
| Address2: | STE 102 | ||||||||
| City: | TIGARD | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972235481 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5036205614 | ||||||||
| FaxNumber: | 5035984688 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/16/2006 | ||||||||
| LastUpdateDate: | 10/27/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207K00000X | OR MD16160 | OR | Y | Allopathic & Osteopathic Physicians | Allergy & Immunology | 207K00000X | WA MD00027120 | WA | N | Allopathic & Osteopathic Physicians | Allergy & Immunology |
ID Information
| ID | Type | State | Issuer | Description | MD16160 | 01 | OR | STATE LICENSE | OTHER |