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General NPI Number Information
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NPI Number | 1902720345
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Entity Type | Organization
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Legal Business Name | NORTHWEST EXTREMITY SPECIALISTS LLC
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Dates
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Enumeration Date | 08/07/2026
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Last Update Date | 08/07/2026
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Provider Practice Location Address
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Address Line | 9115 SW OLESON RD STE 205
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City | PORTLAND
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State | OR
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Zip | 97223-6877
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Country | US
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Telephone | 503-245-2420
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Fax | 503-245-2425
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Provider Business Mailing Address
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Address Line | PO BOX 480024
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City | PORTLAND
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State | OR
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Zip | 97208-4800
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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 | OWNER/PROVIDER
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Name | CLIFFORD DONALD MAH
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Credential | DPM
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Telephone | 503-643-1737
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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