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General NPI Number Information
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NPI Number | 1891741864
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Entity Type | Organization
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Legal Business Name | KNOTT STREET DERMATOLOGY PC
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Dates
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Enumeration Date | 05/25/2006
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Last Update Date | 08/13/2014
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Provider Practice Location Address
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Address Line | 301 NE KNOTT ST
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City | PORTLAND
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State | OR
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Zip | 97212-3014
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Country | US
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Telephone | 503-253-2675
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Fax | 503-253-4297
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Provider Business Mailing Address
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Address Line | 301 NE KNOTT ST
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City | PORTLAND
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State | OR
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Zip | 97212-3014
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Country | US
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Telephone | 503-253-2675
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Fax | 503-253-4297
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ERIC LEIF HANSON
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Credential | MD
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Telephone | 503-253-3910
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | MD26393
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License Number State | OR
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