Healthcare Provider Details

I. General information

NPI: 1245032697
Provider Name (Legal Business Name): PETER EDWARD GIFFORD II
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/26/2025
Last Update Date: 03/26/2025
Certification Date: 03/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12323 SW 66TH AVE
TIGARD OR
97223-8568
US

IV. Provider business mailing address

8373 STONYBRIDGE CIR
HIGHLANDS RANCH CO
80126-7012
US

V. Phone/Fax

Practice location:
  • Phone: 602-816-9421
  • Fax:
Mailing address:
  • Phone: 602-816-9421
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateOR
# 3
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: