Provider Demographics
NPI:1699726877
Name:PIZZUTI, ANSELMO (MD)
Entity type:Individual
Prefix:MR
First Name:ANSELMO
Middle Name:
Last Name:PIZZUTI
Suffix:
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 1:1510 DIVISION ST
Mailing Address - Street 2:SUITE 280
Mailing Address - City:OREGON CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97045
Mailing Address - Country:US
Mailing Address - Phone:503-905-3400
Mailing Address - Fax:503-905-3399
Practice Address - Street 1:200 HAZEL DELL WAY
Practice Address - Street 2:SUITE 202
Practice Address - City:CANBY
Practice Address - State:OR
Practice Address - Zip Code:97013
Practice Address - Country:US
Practice Address - Phone:503-266-8500
Practice Address - Fax:503-266-8585
Is Sole Proprietor?:No
Enumeration Date:2006-05-13
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD07626208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR160879Medicaid
370016731OtherRR PIN
370016731OtherRR PIN
OR160879Medicaid
AP2078740OtherDEA