Healthcare Provider Details

I. General information

NPI: 1619205440
Provider Name (Legal Business Name): PORTLAND JOINT RECONSTRUCTION CLINIC, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/07/2009
Last Update Date: 12/07/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5050 NE HOYT ST SUITE 668
PORTLAND OR
97213-2991
US

IV. Provider business mailing address

5050 NE HOYT STREET SUITE 668
PORTLAND OR
97213-2990
US

V. Phone/Fax

Practice location:
  • Phone: 503-239-7099
  • Fax: 503-239-9459
Mailing address:
  • Phone: 503-239-7099
  • Fax: 503-239-9459

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0114X
TaxonomyAdult Reconstructive Orthopaedic Surgery Physician
License NumberMD11185
License Number StateOR

VIII. Authorized Official

Name: DR. DAVID C HIKES I
Title or Position: OWNER
Credential: M.D.
Phone: 503-239-7099