Provider Demographics
NPI:1538587654
Name:DE HAAN, GENE (MD)
Entity type:Individual
Prefix:DR
First Name:GENE
Middle Name:
Last Name:DE HAAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:GENE
Other - Middle Name:
Other - Last Name:DE HAAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:3350 N INTERSTATE AVE
Mailing Address - Street 2:OBSTRETRICS AND GYNECOLOGY
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97227-3011
Mailing Address - Country:US
Mailing Address - Phone:503-331-6011
Mailing Address - Fax:503-331-6025
Practice Address - Street 1:3350 N INTERSTATE AVE
Practice Address - Street 2:OBSTRETRICS AND GYNECOLOGY
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97227-3011
Practice Address - Country:US
Practice Address - Phone:503-331-6011
Practice Address - Fax:503-331-6025
Is Sole Proprietor?:No
Enumeration Date:2014-04-04
Last Update Date:2018-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR167936207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology