Healthcare Provider Details

I. General information

NPI: 1356385835
Provider Name (Legal Business Name): RAYMOND S EDWARDS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2006
Last Update Date: 03/15/2022
Certification Date: 03/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2801 N GANTENBEIN AVE
PORTLAND OR
97227-1623
US

IV. Provider business mailing address

PO BOX 3409
PORTLAND OR
97208-3409
US

V. Phone/Fax

Practice location:
  • Phone: 503-413-4032
  • Fax: 503-227-0218
Mailing address:
  • Phone: 503-227-2400
  • Fax: 503-227-0218

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberMD21787
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: