Provider Demographics
NPI:1154754208
Name:TUBMAN, ANNA MARIAN (MD)
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:MARIAN
Last Name:TUBMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ANNA
Other - Middle Name:MARIAN
Other - Last Name:GORDON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 22075
Mailing Address - Street 2:
Mailing Address - City:MILWAUKIE
Mailing Address - State:OR
Mailing Address - Zip Code:97269-2075
Mailing Address - Country:US
Mailing Address - Phone:503-353-1278
Mailing Address - Fax:503-353-1273
Practice Address - Street 1:1508 DIVISION ST
Practice Address - Street 2:SUITE 25, PLAZA 2
Practice Address - City:OREGON CITY
Practice Address - State:OR
Practice Address - Zip Code:97045-1582
Practice Address - Country:US
Practice Address - Phone:503-659-4988
Practice Address - Fax:503-353-1234
Is Sole Proprietor?:No
Enumeration Date:2013-08-13
Last Update Date:2016-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD174900207Q00000X
WAMD60574538207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine