Healthcare Provider Details

I. General information

NPI: 1558546416
Provider Name (Legal Business Name): BENZ BONES AND JINTS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2008
Last Update Date: 01/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1960 NW 167TH PL STE 205
BEAVERTON OR
97006-4804
US

IV. Provider business mailing address

1960 NW 167TH PL STE 205
BEAVERTON OR
97006-4804
US

V. Phone/Fax

Practice location:
  • Phone: 503-629-7500
  • Fax: 503-629-7505
Mailing address:
  • Phone: 503-629-7500
  • Fax: 503-629-7505

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMD14378
License Number StateOR

VIII. Authorized Official

Name: A BROOKE BENZ
Title or Position: OFFICER / MC
Credential: MD
Phone: 503-629-7500