Provider Demographics
NPI:1386618601
Name:ABREU, ENRIQUE A (DO)
Entity type:Individual
Prefix:DR
First Name:ENRIQUE
Middle Name:A
Last Name:ABREU
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 NW 14TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97209-2601
Mailing Address - Country:US
Mailing Address - Phone:503-927-5994
Mailing Address - Fax:503-961-8959
Practice Address - Street 1:140 NW 14TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97209-2601
Practice Address - Country:US
Practice Address - Phone:503-927-5994
Practice Address - Fax:503-961-8959
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2015-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDO25617207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8424079Medicaid
OR269726Medicaid
ORP00363785OtherRR MEDICARE
ORI29533Medicare UPIN
OR269726Medicaid
OR131450Medicare PIN
OR131450Medicare PIN