Healthcare Provider Details

I. General information

NPI: 1881097194
Provider Name (Legal Business Name): REED DERMATOLOGY NORTHWEST LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2014
Last Update Date: 10/01/2020
Certification Date: 10/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13305 NW CORNELL RD STE C
PORTLAND OR
97229-5987
US

IV. Provider business mailing address

13305 NW CORNELL RD STE C
PORTLAND OR
97229-5987
US

V. Phone/Fax

Practice location:
  • Phone: 503-765-5000
  • Fax: 866-742-0249
Mailing address:
  • Phone: 503-765-5000
  • Fax: 866-742-0249

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberMD153328
License Number StateOR

VIII. Authorized Official

Name: LISA HOOD
Title or Position: MANAGER
Credential:
Phone: 503-542-0805