Healthcare Provider Details

I. General information

NPI: 1932467008
Provider Name (Legal Business Name): MAXWELL C. FURR, M.D. LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/26/2012
Last Update Date: 04/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2222 NW LOVEJOY ST STE 607
PORTLAND OR
97210-3033
US

IV. Provider business mailing address

2222 NW LOVEJOY ST STE 607
PORTLAND OR
97210-3033
US

V. Phone/Fax

Practice location:
  • Phone: 503-222-3638
  • Fax: 503-223-5139
Mailing address:
  • Phone: 503-222-3638
  • Fax: 503-223-5139

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberA116392
License Number StateCA

VIII. Authorized Official

Name: DR. MAXWELL C FURR
Title or Position: OWNER/PHYSICIAN
Credential: M.D
Phone: 503-222-3638