=====================================================
General NPI Number Information
=====================================================
NPI Number | 1801069539
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WILLAMETTE HEMATOLOGY-ONCOLOGY PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/02/2008
-----------------------------------------------------
Last Update Date | 08/14/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6464 SW BORLAND RD STE B6
-----------------------------------------------------
City | TUALATIN
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97062-8876
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 503-692-3636
-----------------------------------------------------
Fax | 503-692-5019
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6464 SW BORLAND RD STE B6
-----------------------------------------------------
City | TUALATIN
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97062-8876
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 503-692-3636
-----------------------------------------------------
Fax | 503-692-5019
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. CHRISTOPHER NOGEIRE
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 503-692-3636
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | MD12107
-----------------------------------------------------
License Number State | OR
-----------------------------------------------------