Healthcare Provider Details

I. General information

NPI: 1245419969
Provider Name (Legal Business Name): PORTLAND OTOLOGIC CLINIC PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/30/2007
Last Update Date: 10/30/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

545 NE 47TH AVE STE 212
PORTLAND OR
97213-2237
US

IV. Provider business mailing address

545 NE 47TH AVE STE 212
PORTLAND OR
97213-2237
US

V. Phone/Fax

Practice location:
  • Phone: 503-233-5925
  • Fax: 503-233-6140
Mailing address:
  • Phone: 503-233-5925
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0901X
TaxonomyOtology & Neurotology Physician
License NumberMD06685
License Number StateOR

VIII. Authorized Official

Name: DR. JOHN MACNAUGHTON EPLEY
Title or Position: OWNER
Credential: MD
Phone: 503-233-5925