Healthcare Provider Details

I. General information

NPI: 1417788183
Provider Name (Legal Business Name): ADNAN AHMAD PHYSICIAN ASSISTANT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2024
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9701 SW BARNES RD STE 300
PORTLAND OR
97225-6689
US

IV. Provider business mailing address

541 NE 20TH AVE STE 225
PORTLAND OR
97232-2895
US

V. Phone/Fax

Practice location:
  • Phone: 503-297-8081
  • Fax: 503-292-6601
Mailing address:
  • Phone: 503-963-2801
  • Fax: 503-963-2825

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA221244
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: