Healthcare Provider Details

I. General information

NPI: 1952314635
Provider Name (Legal Business Name): PACIFIC ONCOLOGY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2006
Last Update Date: 02/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5050 NE HOYT ST STE 362
PORTLAND OR
97213-2991
US

IV. Provider business mailing address

15700 SW GREYSTONE CT
BEAVERTON OR
97006-6011
US

V. Phone/Fax

Practice location:
  • Phone: 503-232-7000
  • Fax: 503-232-8266
Mailing address:
  • Phone: 503-203-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License Number26633
License Number StateOR

VIII. Authorized Official

Name: PATRICIA COSGROVE
Title or Position: COO
Credential: RN MSN
Phone: 503-203-1000