MEDICARE: DR. MALCOLM LEWIS MCANINCH MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	13341	OR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1508830621
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MALCOLM LEWIS MCANINCH MD

Provider Business Mailing Address
First Line	:	9450 SW BARNES RD
Second Line	:	SUITE 100
City	:	PORTLAND
State	:	OR
Zip	:	97225-6619
Country	:	US
Telephone Number	:	503-292-9560
Fax Number	:	503-292-9510

Provider Business Practice Location Address
First Line	:	9450 SW BARNES RD
Second Line	:	SUITE 100
City	:	PORTLAND
State	:	OR
Zip	:	97225-6619
Country	:	US
Telephone Number	:	503-292-9560
Fax Number	:	503-292-9510

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/15/2006
Last Update Date	:	05/25/2012

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