Healthcare Provider Details

I. General information

NPI: 1295466860
Provider Name (Legal Business Name): CERES PHYSICIANS OREGON PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2022
Last Update Date: 04/30/2025
Certification Date: 04/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2055 NW SAVIER ST STE 150
PORTLAND OR
97209-1325
US

IV. Provider business mailing address

1 DANIEL BURNHAM CT STE 110C
SAN FRANCISCO CA
94109-0456
US

V. Phone/Fax

Practice location:
  • Phone: 971-429-6000
  • Fax: 415-964-5619
Mailing address:
  • Phone: 415-964-5618
  • Fax: 415-964-5619

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License Number
License Number State

VIII. Authorized Official

Name: PETER C KLATSKY
Title or Position: OWNER
Credential: MD
Phone: 415-964-5618