Provider Demographics
NPI:1417740077
Name:ALPENGLOW PSYCHIATRY P.C.
Entity type:Organization
Organization Name:ALPENGLOW PSYCHIATRY P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DEVRAUX
Authorized Official - Middle Name:R
Authorized Official - Last Name:BOSHARD
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:503-926-9460
Mailing Address - Street 1:5441 S MACADAM AVE # 4717
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97239-6106
Mailing Address - Country:US
Mailing Address - Phone:503-926-9460
Mailing Address - Fax:971-350-1563
Practice Address - Street 1:5441 S MACADAM AVE # 4717
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239-6106
Practice Address - Country:US
Practice Address - Phone:503-926-9460
Practice Address - Fax:971-350-1563
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-27
Last Update Date:2025-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Multi-Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty