Healthcare Provider Details

I. General information

NPI: 1235069329
Provider Name (Legal Business Name): ANDREW FISHER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2026
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10700 SW BEAVERTON HILLSDALE HWY STE 11
BEAVERTON OR
97005-3035
US

IV. Provider business mailing address

6828 N MONTANA AVE
PORTLAND OR
97217-5430
US

V. Phone/Fax

Practice location:
  • Phone: 503-641-1475
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156F00000X
TaxonomyTechnician/Technologist
License Number
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: