Provider Demographics
NPI:1063738128
Name:DE OLAZO, AURA THERESA BONDOC (MD)
Entity type:Individual
Prefix:
First Name:AURA THERESA
Middle Name:BONDOC
Last Name:DE OLAZO
Suffix:
Gender:F
Credentials:MD
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:24988 SE STARK ST
Mailing Address - Street 2:MOB 3 SUITE 220
Mailing Address - City:GRESHAM
Mailing Address - State:OR
Mailing Address - Zip Code:97030-8322
Mailing Address - Country:US
Mailing Address - Phone:503-674-1580
Mailing Address - Fax:503-674-1581
Practice Address - Street 1:24988 SE STARK ST
Practice Address - Street 2:MOB 3 SUITE 220
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97030-8322
Practice Address - Country:US
Practice Address - Phone:503-674-1580
Practice Address - Fax:503-674-1581
Is Sole Proprietor?:No
Enumeration Date:2010-04-14
Last Update Date:2011-12-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ORMD150967207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine