Healthcare Provider Details

I. General information

NPI: 1326041948
Provider Name (Legal Business Name): FREDERICK S EY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2005
Last Update Date: 10/17/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15700 SW GREYSTONE COURT
BEAVERTON OR
97006-0000
US

IV. Provider business mailing address

PO BOX 3378
PORTLAND OR
97208-3378
US

V. Phone/Fax

Practice location:
  • Phone: 503-203-1000
  • Fax: 503-203-1010
Mailing address:
  • Phone: 503-203-1000
  • Fax: 503-203-1010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberMD14443
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: