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Specialty details in registry · Portland, OR

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At a glance

3500 Ne Mlk Jr Blvd Ste 200, Portland, OR 97212-2093

NPPES record updated Aug 28, 2018. Public records can lag behind changes at a practice.

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  • Are you accepting new patients?
  • Do you accept my specific insurance plan?
  • Do you provide the service I need at this address?
  • Do I need a referral, and what is the earliest appointment?

Insurance participation and appointment availability are not established by these public records.

Practice location

3500 Ne Mlk Jr Blvd Ste 200
Portland, OR 97212-2093
Professional details: NPI, taxonomy & registry record
NPI1861973786
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Registry details

Primary taxonomy
Specialty details in registry
Taxonomy code
261QM0801X
Enumeration date
Aug 28, 2018
Record updated
Aug 28, 2018
More registry details
Provider type
Organization · Type 2
Other reported name
<UNAVAIL>

Reported taxonomies and licenses

Specialty details in registry

261QM0801X · Primary

License reported: 3767 OR

License numbers and credentials are reported to NPPES; HCPList does not independently verify them.

Practice location

3500 Ne Mlk Jr Blvd Ste 200
Portland, OR 97212-2093
Phone
(503) 680-7292
Fax
(971) 254-4882
Mailing address
1020 NE TILLAMOOK ST

PORTLAND, OR 972124060
Source: NPPES Source through Oct 18, 2026An NPI does not verify licensure or credentials.

Information may be outdated or incomplete. Confirm details directly with the practice. HCPList is an independent directory and is not affiliated with CMS.

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