Provider Demographics
NPI:1255457834
Name:OLLER, DALE NORMA (MD)
Entity type:Individual
Prefix:DR
First Name:DALE
Middle Name:NORMA
Last Name:OLLER
Suffix:
Gender:F
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:PO BOX 13101
Mailing Address - Street 2:PROFESSIONAL PRACTICE MANAGEMENT
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97213-1010
Mailing Address - Country:US
Mailing Address - Phone:503-528-8404
Mailing Address - Fax:503-828-8405
Practice Address - Street 1:5319 SW WESTGATE DR
Practice Address - Street 2:STE 107
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97221
Practice Address - Country:US
Practice Address - Phone:503-203-1777
Practice Address - Fax:503-203-6191
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD178712084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry