Healthcare Provider Details

I. General information

NPI: 1700883386
Provider Name (Legal Business Name): WILLIAM C SCHLIPPERT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/28/2005
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10000 SE MAIN ST SUITE 203
PORTLAND OR
97216
US

IV. Provider business mailing address

10000 SE MAIN ST SUITE 203
PORTLAND OR
97216
US

V. Phone/Fax

Practice location:
  • Phone: 503-255-3054
  • Fax: 503-255-7651
Mailing address:
  • Phone: 503-255-3054
  • Fax: 503-255-7651

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number11373
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: