Healthcare Provider Details

I. General information

NPI: 1770716763
Provider Name (Legal Business Name): ALEX MICHAEL PANDZIK NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2009
Last Update Date: 10/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9775 SE SUNNYSIDE RD SUITE 200
CLACKAMAS OR
97015-5739
US

IV. Provider business mailing address

2051 KAEN RD SUITE 367
OREGON CITY OR
97045-4035
US

V. Phone/Fax

Practice location:
  • Phone: 503-655-8471
  • Fax: 503-723-4907
Mailing address:
  • Phone: 503-742-5300
  • Fax: 503-742-5979

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number201250022NP
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: