Healthcare Provider Details

I. General information

NPI: 1902720345
Provider Name (Legal Business Name): NORTHWEST EXTREMITY SPECIALISTS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/07/2026
Last Update Date: 08/07/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9115 SW OLESON RD STE 205
PORTLAND OR
97223-6877
US

IV. Provider business mailing address

PO BOX 480024
PORTLAND OR
97208-4800
US

V. Phone/Fax

Practice location:
  • Phone: 503-245-2420
  • Fax: 503-245-2425
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: CLIFFORD DONALD MAH
Title or Position: OWNER/PROVIDER
Credential: DPM
Phone: 503-643-1737