Provider Demographics
NPI:1316953219
Name:GELB, MICHAEL ETHAN (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:ETHAN
Last Name:GELB
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1318 NW 20TH AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97209-1671
Mailing Address - Country:US
Mailing Address - Phone:503-223-1514
Mailing Address - Fax:503-227-8058
Practice Address - Street 1:1318 NW 20TH AVE
Practice Address - Street 2:SUITE A
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97209-1671
Practice Address - Country:US
Practice Address - Phone:503-223-1514
Practice Address - Fax:503-227-8058
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2021-11-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
ORMD263912084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
H84676Medicare UPIN