MEDICARE: PAULA A VANDERFORD M.D.

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	2080H0002X	Pediatric Hospice and Palliative Medicine Physician	MD28634	OR
2	208000000X	Pediatrics Physician	MD28634	OR
3	2080H0002X	Pediatric Hospice and Palliative Medicine Physician	2022038337	MO
4	2080P0203X	Pediatric Critical Care Medicine Physician	MD28634	OR

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	R144108	OTHER	OR	MEDICARE PTAN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	028523	OTHER	OR	DMAP

General Provider Information

NPI Number	:	1053304006
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAULA A VANDERFORD M.D.

Provider Business Mailing Address
First Line	:	3181 SW SAM JACKSON PARK RD
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97239-3011
Country	:	US
Telephone Number	:	503-346-0640
Fax Number	:	503-418-9959

Provider Business Practice Location Address
First Line	:	3181 SW SAM JACKSON PARK RD
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97239-3011
Country	:	US
Telephone Number	:	503-346-0640
Fax Number	:	503-418-9959

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/24/2005
Last Update Date	:	10/17/2024

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Directions to “ PAULA A VANDERFORD M.D.” Practice Location

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