Healthcare Provider Details

I. General information

NPI: 1912103367
Provider Name (Legal Business Name): OREGON FOOT AND ANKLE SPECIALISTS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2007
Last Update Date: 07/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17200 NW CORRIDOR CT STE 108
BEAVERTON OR
97006-3295
US

IV. Provider business mailing address

17200 NW CORRIDOR CT STE 108
BEAVERTON OR
97006-3295
US

V. Phone/Fax

Practice location:
  • Phone: 503-292-9252
  • Fax: 503-992-6780
Mailing address:
  • Phone: 503-292-9252
  • Fax: 503-992-6780

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberD9000164
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: DR. BRIAN G ORAHOOD
Title or Position: OWNER
Credential: DPM
Phone: 503-292-9252