Healthcare Provider Details

I. General information

NPI: 1396716627
Provider Name (Legal Business Name): PACIFIC DIGESTIVE ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15775 SE 82ND DR
CLACKAMAS OR
97015-8551
US

IV. Provider business mailing address

15775 SE 82ND DR
CLACKAMAS OR
97015-8551
US

V. Phone/Fax

Practice location:
  • Phone: 503-722-9155
  • Fax: 503-722-0420
Mailing address:
  • Phone: 503-722-9155
  • Fax: 503-722-0420

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MS. LINDA J WILLIAMS
Title or Position: OFFICE MANAGER
Credential:
Phone: 503-496-0354