Provider Demographics
NPI:1588695035
Name:SIQUEIRA, CARMELINDO JR (MD)
Entity type:Individual
Prefix:DR
First Name:CARMELINDO
Middle Name:
Last Name:SIQUEIRA
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9155 SW BARNES RD
Mailing Address - Street 2:SUITE 310
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97225-6630
Mailing Address - Country:US
Mailing Address - Phone:503-293-8491
Mailing Address - Fax:503-297-8492
Practice Address - Street 1:9155 SW BARNES RD
Practice Address - Street 2:SUITE 310
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97225-6625
Practice Address - Country:US
Practice Address - Phone:503-293-8491
Practice Address - Fax:503-297-8492
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2008-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD13262207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR279190Medicaid
C91308Medicare UPIN
OR00WCGZKBMedicare PIN