Healthcare Provider Details

I. General information

NPI: 1346494135
Provider Name (Legal Business Name): ANTHONY GEORGE ESAU ND
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/06/2008
Last Update Date: 11/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10420 NE SANDY BLVD
PORTLAND OR
97220-3363
US

IV. Provider business mailing address

10420 NE SANDY BLVD
PORTLAND OR
97220-3363
US

V. Phone/Fax

Practice location:
  • Phone: 503-252-4358
  • Fax: 503-253-7765
Mailing address:
  • Phone: 503-252-4358
  • Fax: 503-253-7765

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number0739
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: