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General NPI Number Information
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NPI Number | 1033451265
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Entity Type | Organization
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Legal Business Name | GREATER PORTLAND NEUROSURGICAL CENTER, PC
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Dates
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Enumeration Date | 03/26/2013
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Last Update Date | 08/15/2013
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Provider Practice Location Address
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Address Line | 24900 SE STARK ST STE 209
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City | GRESHAM
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State | OR
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Zip | 97030-3382
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Country | US
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Telephone | 503-665-5522
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Fax | 503-665-8822
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Provider Business Mailing Address
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Address Line | 24900 SE STARK ST STE 209
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City | GRESHAM
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State | OR
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Zip | 97030-3382
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Country | US
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Telephone | 503-665-5522
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Fax | 503-665-8822
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Authorized Official
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Title or Position | OWNER
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Name | DR. JULIO ORDONEZ
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Credential | MD
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Telephone | 503-665-5522
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207T00000X
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Taxonomy Name | Neurological Surgery Physician
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License Number | MD11164
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License Number State | OR
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