Healthcare Provider Details

I. General information

NPI: 1184250870
Provider Name (Legal Business Name): BRIDGEWAY ONCOLOGY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2020
Last Update Date: 06/04/2020
Certification Date: 06/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17610 SW ALEXANDER ST
BEAVERTON OR
97003-4411
US

IV. Provider business mailing address

17610 SW ALEXANDER ST
BEAVERTON OR
97003-4411
US

V. Phone/Fax

Practice location:
  • Phone: 503-481-4594
  • Fax: 503-210-1445
Mailing address:
  • Phone: 503-481-4594
  • Fax: 503-210-1445

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. STEVE STEVE FU
Title or Position: OWNER/ CEO
Credential: MD, PHD.
Phone: 503-481-4594