1467565119 NPI number — SCOTT ALAN SANDBERG M.D.

Table of content: SCOTT ALAN SANDBERG M.D. (NPI 1467565119)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467565119 NPI number — SCOTT ALAN SANDBERG M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SANDBERG
Provider First Name:
SCOTT
Provider Middle Name:
ALAN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1467565119
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/04/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3500 N INTERSTATE AVE
Provider Second Line Business Mailing Address:
DEPARTMENT OF RADIOLOGY
Provider Business Mailing Address City Name:
PORTLAND
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97227-1196
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
503-285-9321
Provider Business Mailing Address Fax Number:
503-652-2880

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3500 N INTERSTATE AVE
Provider Second Line Business Practice Location Address:
DEPARTMENT OF RADIOLOGY
Provider Business Practice Location Address City Name:
PORTLAND
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97227-1196
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-285-9321
Provider Business Practice Location Address Fax Number:
503-652-2880
Provider Enumeration Date:
08/16/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2085R0202X , with the licence number:  MD00034714 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0202X , with the licence number: MD18514 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)