Healthcare Provider Details

I. General information

NPI: 1396787727
Provider Name (Legal Business Name): DIAGNOSTIC IMAGING, NW PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1015 NW 22ND AVE STE T240
PORTLAND OR
97210-3025
US

IV. Provider business mailing address

PO BOX 3730 DINW#103
PORTLAND OR
97208-3730
US

V. Phone/Fax

Practice location:
  • Phone: 503-413-7127
  • Fax: 503-413-8169
Mailing address:
  • Phone: 800-878-6698
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: ROBERT SHELEY
Title or Position: DIRECTOR
Credential: MD
Phone: 503-413-7111