Healthcare Provider Details

I. General information

NPI: 1003785874
Provider Name (Legal Business Name): TOBY J COGHILL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/31/2025
Last Update Date: 10/31/2025
Certification Date: 10/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

335 SE 8TH AVE
HILLSBORO OR
97123-4246
US

IV. Provider business mailing address

3545 SW 123RD AVE
BEAVERTON OR
97005-1721
US

V. Phone/Fax

Practice location:
  • Phone: 503-681-1111
  • Fax:
Mailing address:
  • Phone: 503-995-9240
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number201631
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: