Healthcare Provider Details

I. General information

NPI: 1033451265
Provider Name (Legal Business Name): GREATER PORTLAND NEUROSURGICAL CENTER, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2013
Last Update Date: 08/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24900 SE STARK ST STE 209
GRESHAM OR
97030-3382
US

IV. Provider business mailing address

24900 SE STARK ST STE 209
GRESHAM OR
97030-3382
US

V. Phone/Fax

Practice location:
  • Phone: 503-665-5522
  • Fax: 503-665-8822
Mailing address:
  • Phone: 503-665-5522
  • Fax: 503-665-8822

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License NumberMD11164
License Number StateOR

VIII. Authorized Official

Name: DR. JULIO ORDONEZ
Title or Position: OWNER
Credential: MD
Phone: 503-665-5522