Healthcare Provider Details

I. General information

NPI: 1619995172
Provider Name (Legal Business Name): NORTHWEST UROLOGICAL CLINIC PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 03/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2230 NW PETTYGROVE ST SUITE 210
PORTLAND OR
97210-2659
US

IV. Provider business mailing address

2230 NW PETTYGROVE ST SUITE 210
PORTLAND OR
97210-2659
US

V. Phone/Fax

Practice location:
  • Phone: 503-223-6223
  • Fax: 503-223-3665
Mailing address:
  • Phone: 503-223-6223
  • Fax: 503-223-3665

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: DR. DAVID BRIAN LASHLEY
Title or Position: PARTNER
Credential:
Phone: 503-223-6223