Healthcare Provider Details

I. General information

NPI: 1720777196
Provider Name (Legal Business Name): RACHEL ANN DAWSON PEER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2023
Last Update Date: 05/02/2023
Certification Date: 05/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4101 NE DIVISION ST STE 100
GRESHAM OR
97030-4617
US

IV. Provider business mailing address

39710 SE PAUL MOORE RD
SANDY OR
97055-6600
US

V. Phone/Fax

Practice location:
  • Phone: 506-666-3808
  • Fax:
Mailing address:
  • Phone: 253-213-9822
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number107176
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: