Healthcare Provider Details

I. General information

NPI: 1972332161
Provider Name (Legal Business Name): FLYNN ANDREW ROBERTSON PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2024
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15895 SW 72ND AVE STE 250
TIGARD OR
97224-7966
US

IV. Provider business mailing address

15895 SW 72ND AVE STE 250
TIGARD OR
97224-7966
US

V. Phone/Fax

Practice location:
  • Phone: 503-624-5630
  • Fax:
Mailing address:
  • Phone: 503-624-5630
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA227998
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: