Healthcare Provider Details

I. General information

NPI: 1316977309
Provider Name (Legal Business Name): KATJA F DAOUD MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/04/2006
Last Update Date: 09/24/2020
Certification Date: 09/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5050 NE HOYT ST STE 155
PORTLAND OR
97225-2956
US

IV. Provider business mailing address

PO BOX 3158
PORTLAND OR
97208-3158
US

V. Phone/Fax

Practice location:
  • Phone: 503-215-6819
  • Fax: 503-215-6492
Mailing address:
  • Phone: 503-215-6494
  • Fax: 503-215-6644

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License NumberMD22415
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: