MEDICARE: DR PEPEL FAMILY PRACTICE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2300X	Primary Care Clinic/Center	393160-96	OR

General Provider Information

NPI Number	:	1043516289
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR PEPEL FAMILY PRACTICE

Provider Business Mailing Address
First Line	:	15880 QUARRY RD
Second Line	:
City	:	LAKE OSWEGO
State	:	OR
Zip	:	97035-3336
Country	:	US
Telephone Number	:	503-232-3302
Fax Number	:	503-200-2895

Provider Business Practice Location Address
First Line	:	15880 QUARRY RD
Second Line	:
City	:	LAKE OSWEGO
State	:	OR
Zip	:	97035-3336
Country	:	US
Telephone Number	:	503-232-3302
Fax Number	:	503-200-2895

Authorized Official
Title or Position	:	OWNER
Name	:	DR. MIHAELA PEPEL
Credential	:	MD, ND
Telephone Number	:	503-232-3302

Provider Enumeration Date	:	02/06/2011
Last Update Date	:	02/06/2011

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