Unknown Individual – Physician Assistant, NPI 1629184312
Physician Assistant
Main info
Profile Insights
NPPES metrics only — not quality of care.
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Provider Addresses for Unknown Individual
Southeast Stark Street, Russellville, Mill Park, Portland, Metro, Multnomah County, Oregon, 97216, United States
PORTLAND, OR 972335757
Phone: (503) 669-3900
Type: Location
326, Northeast 27th Street, Twelvemile Corner, North Central, Gresham, Multnomah County, Oregon, 97030, United States
GRESHAM, OR 970307703
Phone: (503) 492-8552
Fax: (503) 492-8552
Type: Mailing
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
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Medicare Enrollment & Revalidation
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No Medicare enrollment or revalidation data available for this provider in our database.
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Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
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No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 97233)
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