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General NPI Number Information
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NPI Number | 1841772233
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Entity Type | Organization
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Legal Business Name | PSYCHIATRIST ON-CALL, LLC
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Dates
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Enumeration Date | 08/31/2018
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Last Update Date | 08/31/2018
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Provider Practice Location Address
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Address Line | 12655 SW CENTER ST STE 150
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City | BEAVERTON
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State | OR
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Zip | 97005-1864
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Country | US
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Telephone | 503-832-0945
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Fax |
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Provider Business Mailing Address
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Address Line | 12655 SW CENTER ST STE 150
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City | BEAVERTON
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State | OR
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Zip | 97005-1864
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Country | US
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Telephone | 503-832-0945
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | GILBERT M. SIMAS
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Credential | MD
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Telephone | 503-880-6414
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | MD165076
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License Number State | OR
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