Healthcare Provider Details

I. General information

NPI: 1346627551
Provider Name (Legal Business Name): ANDREW WILLIAMS D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2015
Last Update Date: 04/28/2022
Certification Date: 04/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16100 NW CORNELL RD STE 220
BEAVERTON OR
97006-7334
US

IV. Provider business mailing address

16100 NW CORNELL RD STE 220
BEAVERTON OR
97006-7334
US

V. Phone/Fax

Practice location:
  • Phone: 503-878-8885
  • Fax: 971-297-1360
Mailing address:
  • Phone: 503-878-8885
  • Fax: 971-297-1360

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberDO.OP.61107091-IMLC
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number12573352-1204
License Number StateUT
# 3
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number007117
License Number StateAZ
# 4
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberDO191028
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: