Healthcare Provider Details

I. General information

NPI: 1457055436
Provider Name (Legal Business Name): COLIN PATRICK BOEHNLEIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2023
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4855 SW WESTERN AVE
BEAVERTON OR
97005-3460
US

IV. Provider business mailing address

4855 SW WESTERN AVE
BEAVERTON OR
97005-3460
US

V. Phone/Fax

Practice location:
  • Phone: 503-643-7565
  • Fax: 503-626-4418
Mailing address:
  • Phone: 503-643-7565
  • Fax: 503-626-4418

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD232415
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD.MD.70163144
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: