Healthcare Provider Details

I. General information

NPI: 1720214422
Provider Name (Legal Business Name): BENJAMIN ANDREW ADLER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2009
Last Update Date: 08/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4455 NE HIGHWAY 20
CORVALLIS OR
97330
US

IV. Provider business mailing address

3415 SE POWELL BOULEVARD
PORTLAND OR
97202
US

V. Phone/Fax

Practice location:
  • Phone: 541-758-5900
  • Fax: 541-752-9270
Mailing address:
  • Phone: 503-234-9591
  • Fax: 541-752-9270

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberMD166395
License Number StateOR

VII. Legacy identifiers

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: