Provider Demographics
NPI:1962518662
Name:TUBBS, WARREN SCOTT (MD)
Entity type:Individual
Prefix:DR
First Name:WARREN
Middle Name:SCOTT
Last Name:TUBBS
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 1:233 NE 102ND AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97220-4106
Mailing Address - Country:US
Mailing Address - Phone:503-253-1105
Mailing Address - Fax:503-535-8398
Practice Address - Street 1:233 NE 102ND AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97220-4106
Practice Address - Country:US
Practice Address - Phone:503-253-1105
Practice Address - Fax:503-535-8398
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD195792085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
F44912Medicare UPIN
ORODWCGNQHMedicare ID - Type Unspecified