Healthcare Provider Details

I. General information

NPI: 1902090061
Provider Name (Legal Business Name): KHALED RASHAD PHARAON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2007
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 NE 87TH AVE SUITE 301
VANCOUVER WA
98664-1989
US

IV. Provider business mailing address

505 NE 87TH AVE STE 301
VANCOUVER WA
98664-1965
US

V. Phone/Fax

Practice location:
  • Phone: 360-514-1854
  • Fax: 360-514-6063
Mailing address:
  • Phone: 360-514-1854
  • Fax: 360-514-6063

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License NumberMD156740
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License NumberMD60365023
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code2086S0127X
TaxonomyTrauma Surgery Physician
License NumberMD156740
License Number StateOR
# 4
Primary TaxonomyY
Taxonomy Code2086S0127X
TaxonomyTrauma Surgery Physician
License NumberMD60365023
License Number StateWA
# 5
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMD156740
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: