Healthcare Provider Details

I. General information

NPI: 1407905037
Provider Name (Legal Business Name): DEJAN MILORAD DORDEVICH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/10/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

545 NE 47TH AVE STE 301
PORTLAND OR
97213-2287
US

IV. Provider business mailing address

545 NE 47TH AVE STE 301
PORTLAND OR
97213-2287
US

V. Phone/Fax

Practice location:
  • Phone: 503-231-7622
  • Fax:
Mailing address:
  • Phone: 503-231-7622
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RA0201X
TaxonomyAllergy & Immunology (Internal Medicine) Physician
License NumberMD10741
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: