Healthcare Provider Details

I. General information

NPI: 1538261573
Provider Name (Legal Business Name): ERIKO ONISHI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2006
Last Update Date: 11/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3303 SW BOND AVE
PORTLAND OR
97239-4501
US

IV. Provider business mailing address

3303 SW BOND AVE
PORTLAND OR
97239-4501
US

V. Phone/Fax

Practice location:
  • Phone: 503-494-8573
  • Fax:
Mailing address:
  • Phone: 503-494-8573
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number01053139
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD154762
License Number StateOR
# 3
Primary TaxonomyN
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License NumberMD154762
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: