Healthcare Provider Details

I. General information

NPI: 1043262116
Provider Name (Legal Business Name): PACIFIC ONCOLOGY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 02/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15700 SW GREYSTONE CT
BEAVERTON OR
97006-6011
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: 503-203-1000

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number
License Number State

VIII. Authorized Official

Name: WILLIAM M MOONEY
Title or Position: PRESIDENT, CEO
Credential: MD
Phone: 503-203-1000