Healthcare Provider Details

I. General information

NPI: 1881751071
Provider Name (Legal Business Name): PAUL DOUGLAS PICKERING M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/03/2007
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7431 NE EVERGREEN PKWY STE 100
HILLSBORO OR
97124-5831
US

IV. Provider business mailing address

7650 SW BEVELAND STREET SUITE 200
PORTLAND OR
97223
US

V. Phone/Fax

Practice location:
  • Phone: 503-840-3400
  • Fax: 503-840-3409
Mailing address:
  • Phone: 503-601-3615
  • Fax: 503-840-3299

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMD175483
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: