Healthcare Provider Details

I. General information

NPI: 1558700781
Provider Name (Legal Business Name): CHAD ESTERBERG PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2013
Last Update Date: 12/29/2021
Certification Date: 12/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2875 NE STUCKI AVE
HILLSBORO OR
97124-5806
US

IV. Provider business mailing address

2875 NE STUCKI AVE
HILLSBORO OR
97124-5806
US

V. Phone/Fax

Practice location:
  • Phone: 971-310-3234
  • Fax:
Mailing address:
  • Phone: 971-310-3234
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA162184
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: