Healthcare Provider Details

I. General information

NPI: 1124429329
Provider Name (Legal Business Name): DAHRA PERKINS MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2014
Last Update Date: 04/12/2024
Certification Date: 04/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2230 NW PETTYGROVE ST STE 110
PORTLAND OR
97210-2659
US

IV. Provider business mailing address

2230 NW PETTYGROVE ST STE 110
PORTLAND OR
97210-2659
US

V. Phone/Fax

Practice location:
  • Phone: 503-227-0350
  • Fax: 503-227-0745
Mailing address:
  • Phone: 503-227-0350
  • Fax: 503-227-0745

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. DAHRA DIANE PERKINS
Title or Position: OWNER
Credential: M.D.
Phone: 503-227-0350