Healthcare Provider Details

I. General information

NPI: 1265060131
Provider Name (Legal Business Name): ANDREW RAY MEREDITH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2020
Last Update Date: 10/07/2025
Certification Date: 10/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9205 SW BARNES RD
PORTLAND OR
97225-6603
US

IV. Provider business mailing address

9155 SW BARNES RD STE 420
PORTLAND OR
97225-6631
US

V. Phone/Fax

Practice location:
  • Phone: 503-216-1234
  • Fax:
Mailing address:
  • Phone: 503-297-6334
  • Fax: 503-297-2360

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberMD220555
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: