Healthcare Provider Details

I. General information

NPI: 1942283676
Provider Name (Legal Business Name): DARRELL MARTIN POLSTER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/28/2005
Last Update Date: 11/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

335 SE 8TH AVE
HILLSBORO OR
97123-4246
US

IV. Provider business mailing address

8905 SW NIMBUS AVE SUITE 300
BEAVERTON OR
97008-7136
US

V. Phone/Fax

Practice location:
  • Phone: 503-681-1270
  • Fax:
Mailing address:
  • Phone: 503-372-2740
  • Fax: 503-372-2754

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number35084131P
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberMD171659
License Number StateOR
# 3
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberG88700
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: