MEDICARE: DR. HOWARD I GANDLER 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	207RR0500X	Rheumatology Physician	MD17774	OR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1164429130
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HOWARD I GANDLER M.D.

Provider Business Mailing Address
First Line	:	2230 NW PETTYGROVE
Second Line	:	#120
City	:	PORTLAND
State	:	OR
Zip	:	97210
Country	:	US
Telephone Number	:	503-223-1840
Fax Number	:	503-274-8970

Provider Business Practice Location Address
First Line	:	2230 NW PETTYGROVE
Second Line	:	#120
City	:	PORTLAND
State	:	OR
Zip	:	97210
Country	:	US
Telephone Number	:	503-223-1840
Fax Number	:	503-274-8970

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

Provider Enumeration Date	:	07/05/2005
Last Update Date	:	03/29/2010

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