Provider Demographics
NPI:1043307812
Name:SOLEM, DANA L (MD)
Entity type:Individual
Prefix:DR
First Name:DANA
Middle Name:L
Last Name:SOLEM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:6950 SW HAMPTON ST
Mailing Address - Street 2:SUITE 222
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97223
Mailing Address - Country:US
Mailing Address - Phone:503-430-7948
Mailing Address - Fax:503-620-8119
Practice Address - Street 1:6950 SW HAMPTON ST
Practice Address - Street 2:SUITE 222
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97223
Practice Address - Country:US
Practice Address - Phone:503-430-7948
Practice Address - Fax:503-620-8119
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2012-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD119122084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
R114144Medicare ID - Type Unspecified