Healthcare Provider Details

I. General information

NPI: 1093702862
Provider Name (Legal Business Name): KOENRAAD DE GEEST MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: KOEN DE GEEST

II. Dates (important events)

Enumeration Date: 10/05/2005
Last Update Date: 03/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3181 SW SAM JACKSON PARK RD MC:L466
PORTLAND OR
97239-3011
US

IV. Provider business mailing address

3181 SW SAM JACKSON PARK RD MC:L466
PORTLAND OR
97239-3011
US

V. Phone/Fax

Practice location:
  • Phone: 503-418-4500
  • Fax: 503-494-4473
Mailing address:
  • Phone: 503-418-4500
  • Fax: 503-494-4473

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License Number35280
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License NumberMD162819
License Number StateOR
# 3
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMD162819
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: