Healthcare Provider Details

I. General information

NPI: 1265897599
Provider Name (Legal Business Name): DAVID E STRICKLAND PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/31/2015
Last Update Date: 01/05/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24900 SE STARK ST STE 109
GRESHAM OR
97030-3381
US

IV. Provider business mailing address

PO BOX 4365
PORTLAND OR
97208-4365
US

V. Phone/Fax

Practice location:
  • Phone: 503-674-1950
  • Fax: 503-674-1965
Mailing address:
  • Phone: 503-413-3900
  • Fax: 503-413-3710

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA1691
License Number StateNV

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: