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General NPI Number Information
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NPI Number | 1083721625
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Entity Type | Organization
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Legal Business Name | ORTHOPEDIC SPECIALISTS, PC
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Dates
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Enumeration Date | 08/23/2006
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Last Update Date | 04/06/2010
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Provider Practice Location Address
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Address Line | 5050 NE HOYT ST STE 340
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City | PORTLAND
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State | OR
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Zip | 97213-2991
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Country | US
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Telephone | 503-234-9861
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Fax | 503-238-0873
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Provider Business Mailing Address
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Address Line | 5050 NE HOYT ST STE 340
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City | PORTLAND
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State | OR
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Zip | 97213-2991
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Country | US
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Telephone | 503-234-9861
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Fax | 503-238-0873
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Authorized Official
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Title or Position | PRESIDENT
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Name | MICHAEL B WYMAN
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Credential | MD
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Telephone | 503-234-9861
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number |
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License Number State |
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