Physician Compare National (NPI:1356305924)

HEALTHCARE PROVIDER: KEITH L VALACHI

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1356305924
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	1153496823
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20080814000167
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	VALACHI
	Individual professional last name
Provider First Name	KEITH
	Individual professional first name
Provider Middle Name	L
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	BAYLOR COLLEGE OF MEDICINE
	Individual professional's medical school
Graduation Year	1987
	Individual professional's medical school graduation year
Primary Specialty	ORAL SURGERY
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	9900 SW WILSHIRE ST
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 120
	Group Practice or individual's line 2 address
City	PORTLAND
	Group Practice or individual's city
State	OR
	Group Practice or individual's state
Zip Code	972255065
	Group Practice or individual's zip code (9 digits when available)
Phone Number	9712717478101
	Phone number is listed only when there is a single phone number available for the practice location address

Hospital(s) Affiliation Information
Professional Accepts Medicare Assignment	M