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General NPI Number Information
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NPI Number | 1619273844
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Entity Type | Organization
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Legal Business Name | NORTHWEST ENDOCRINOLOGY, LLC
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Dates
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Enumeration Date | 02/05/2011
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Last Update Date | 03/08/2011
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Provider Practice Location Address
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Address Line | 16463 BOONES FERRY RD SUITE 300
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City | LAKE OSWEGO
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State | OR
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Zip | 97035-4259
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Country | US
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Telephone | 503-303-8377
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Fax |
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Provider Business Mailing Address
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Address Line | 328 SW HAMILTON ST
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City | PORTLAND
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State | OR
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Zip | 97239-4036
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. TROY DILLARD
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Credential | M.D.
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Telephone | 503-897-0403
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RE0101X
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Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
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License Number | MD28838
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License Number State | OR
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