Healthcare Provider Details

I. General information

NPI: 1982626057
Provider Name (Legal Business Name): ROGER HOHNSTEIN LMT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2006
Last Update Date: 06/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 NE BROADWAY ST STE 125
PORTLAND OR
97232-1569
US

IV. Provider business mailing address

2100 NE BROADWAY ST STE 125
PORTLAND OR
97232-1500
US

V. Phone/Fax

Practice location:
  • Phone: 503-477-8222
  • Fax: 971-373-8648
Mailing address:
  • Phone: 503-477-8222
  • Fax: 971-373-8648

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number3904
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: