1508812066 NPI number — EDWARD S PHINNEY JR, MD, PC

Table of content: (NPI 1508812066)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508812066 NPI number — EDWARD S PHINNEY JR, MD, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EDWARD S PHINNEY JR, MD, PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1508812066
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/11/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3439 NE SANDY BLVD
Provider Second Line Business Mailing Address:
PMB 375
Provider Business Mailing Address City Name:
PORTLAND
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97232-1959
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
503-284-8841
Provider Business Mailing Address Fax Number:
503-282-3302

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9155 SW BARNES RD
Provider Second Line Business Practice Location Address:
SUITE 217
Provider Business Practice Location Address City Name:
PORTLAND
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97225-6625
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-297-1548
Provider Business Practice Location Address Fax Number:
503-297-0230
Provider Enumeration Date:
05/26/2006

Additional Information

Authorized Official

Authorized Official Last Name:
PHINNEY
Authorized Official First Name:
EDWARD
Authorized Official Middle Name:
S
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
503-297-1548

Provider Taxonomy Codes

  • Taxonomy code: 208600000X , with the licence number:  MD13227 , 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)





Copyright © 2007-2025 www.npivalidator.com