Provider Demographics
NPI:1447538533
Name:ALE, SAMIR BIR (MD)
Entity type:Individual
Prefix:
First Name:SAMIR
Middle Name:BIR
Last Name:ALE
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 1:1900 WOODLAND DR
Mailing Address - Street 2:
Mailing Address - City:COOS BAY
Mailing Address - State:OR
Mailing Address - Zip Code:97420-2045
Mailing Address - Country:US
Mailing Address - Phone:541-267-5151
Mailing Address - Fax:541-266-4557
Practice Address - Street 1:1900 WOODLAND DR
Practice Address - Street 2:
Practice Address - City:COOS BAY
Practice Address - State:OR
Practice Address - Zip Code:97420-2045
Practice Address - Country:US
Practice Address - Phone:541-267-5151
Practice Address - Fax:541-266-4557
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-24
Last Update Date:2014-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
ORMD166344207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR1407812365OtherGROUP NPI NORTH BEND MEDICAL CENTER
OR500672860Medicaid
ORR0000WFBTVOtherGROUP MEDICARE NORTH BEND MEDICAL CENTER
OR93-0635514OtherGROUP TAX ID NORTH BEND MEDICAL CENTER
OR161133OtherGROUP MEDICAID NORTH BEND MEDICAL CENTER