Provider Demographics
NPI:1194760884
Name:HONIS, GRETEL ELIZABETH (MD)
Entity type:Individual
Prefix:
First Name:GRETEL
Middle Name:ELIZABETH
Last Name:HONIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 SE WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:OR
Mailing Address - Zip Code:97338-2834
Mailing Address - Country:US
Mailing Address - Phone:503-623-8301
Mailing Address - Fax:
Practice Address - Street 1:525 SE WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:OR
Practice Address - Zip Code:97338-2834
Practice Address - Country:US
Practice Address - Phone:503-623-8301
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-18
Last Update Date:2013-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD26698207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR025349029OtherBSOR
OR006053Medicaid
I61445Medicare UPIN
OR006053Medicaid
ORR135157Medicare PIN