1073555124 NPI number — TERRANCE A FINSTAD MD

Table of content: TERRANCE A FINSTAD MD (NPI 1073555124)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073555124 NPI number — TERRANCE A FINSTAD MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FINSTAD
Provider First Name:
TERRANCE
Provider Middle Name:
A
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1073555124
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/17/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 35145 LB 1154
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SEATTLE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98124-5145
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
541-387-6328
Provider Business Mailing Address Fax Number:
541-387-6410

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
811 13TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HOOD RIVER
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97031-1204
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-490-9474
Provider Business Practice Location Address Fax Number:
541-387-6410
Provider Enumeration Date:
06/12/2006

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:  MD00036113 , 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: MD20980 , 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)

  • Identifier: 1109487 . This is a "DSHS" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 134467 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".
  • Identifier: AB1795 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".




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