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General NPI Number Information
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NPI Number | 1508857657
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Entity Type | Organization
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Legal Business Name | PORTLAND FAMILY PRACTICE INC.
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Dates
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Enumeration Date | 10/28/2005
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Last Update Date | 01/27/2011
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Provider Practice Location Address
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Address Line | 541 NE 20TH AVE SUITE 210
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City | PORTLAND
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State | OR
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Zip | 97232-2862
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Country | US
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Telephone | 503-233-6940
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Fax | 503-236-2676
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Provider Business Mailing Address
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Address Line | 541 NE 20TH AVE SUITE 210
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City | PORTLAND
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State | OR
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Zip | 97232-2862
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Country | US
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Telephone | 503-233-6940
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Fax | 503-236-2676
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Authorized Official
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Title or Position | PHYSICIAN
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Name | MR. EUGENE UPHOFF
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Credential | M.D.
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Telephone | 503-233-6940
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 358997
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License Number State | OR
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