Healthcare Provider Details

I. General information

NPI: 1881990570
Provider Name (Legal Business Name): CASCADE FAMILY PRACTICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/28/2011
Last Update Date: 01/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7215 SE MILWAUKIE AVE
PORTLAND OR
97202-6103
US

IV. Provider business mailing address

7215 SE MILWAUKIE AVE
PORTLAND OR
97202-6103
US

V. Phone/Fax

Practice location:
  • Phone: 503-233-5273
  • Fax: 503-236-2796
Mailing address:
  • Phone: 503-233-5273
  • Fax: 503-236-2796

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code204C00000X
TaxonomySports Medicine (Neuromusculoskeletal Medicine) Physician
License NumberDO12690
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberDO12690
License Number StateOR

VIII. Authorized Official

Name: DR. CARL M ERICKSON
Title or Position: FAMILY PRACTICE
Credential: D.O.
Phone: 503-233-5273