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General NPI Number Information
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NPI Number | 1649081258
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Entity Type | Organization
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Legal Business Name | OREGON PEDIATRICS-BEAVERTON, LLC
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Dates
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Enumeration Date | 01/14/2025
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Last Update Date | 01/14/2025
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Provider Practice Location Address
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Address Line | 15950 SW MILLIKAN WAY STE 100
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City | BEAVERTON
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State | OR
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Zip | 97003-5170
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Country | US
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Telephone | 503-659-1694
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Fax | 503-659-8984
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Provider Business Mailing Address
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Address Line | 8645 SE SUNNYBROOK BLVD STE 200
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City | CLACKAMAS
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State | OR
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Zip | 97015-6841
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Country | US
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Telephone | 503-659-1694
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Fax | 503-659-8984
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | ANKUR SHAH
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Credential | MD, PHD
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Telephone | 503-659-1694
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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