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General NPI Number Information
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NPI Number | 1962543256
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Entity Type | Organization
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Legal Business Name | SPECIALTY NEURO, P.C.
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Dates
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Enumeration Date | 02/09/2007
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Last Update Date | 11/21/2007
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Provider Practice Location Address
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Address Line | 1800 NE 2ND AVE
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City | PORTLAND
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State | OR
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Zip | 97212-3932
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Country | US
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Telephone | 503-579-5000
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Fax | 503-579-5000
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Provider Business Mailing Address
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Address Line | PO BOX 219009
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City | PORTLAND
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State | OR
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Zip | 97225-9009
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Country | US
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Telephone | 503-579-5000
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Fax | 503-579-5000
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Authorized Official
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Title or Position | PHYSICIAN DIRECTOR
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Name | DR. DAVID ALAN SIKER
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Credential | M.D.
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Telephone | 503-579-5000
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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 | MD22182
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License Number State | OR
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