Healthcare Provider Details

I. General information

NPI: 1356013262
Provider Name (Legal Business Name): SAMUEL PHILIP DEVORE PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2021
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10670 NE CORNELL RD BLDG B
HILLSBORO OR
97124-9220
US

IV. Provider business mailing address

3820 S RIVER PKWY APT 509
PORTLAND OR
97239-4845
US

V. Phone/Fax

Practice location:
  • Phone: 503-216-9300
  • Fax:
Mailing address:
  • Phone: 541-910-0627
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: