Healthcare Provider Details

I. General information

NPI: 1427753409
Provider Name (Legal Business Name): ANGELA PETERSON DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2023
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 DIVISION ST
OREGON CITY OR
97045-1527
US

IV. Provider business mailing address

1500 DIVISION ST
OREGON CITY OR
97045-1527
US

V. Phone/Fax

Practice location:
  • Phone: 503-656-1631
  • Fax:
Mailing address:
  • Phone: 503-656-1631
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberDO229450
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: