MEDICARE: JOHN TAKACS DO

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	207Q00000X	Family Medicine Physician	DO15382	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
2	048825002	OTHER	OR	BCBSO

General Provider Information

NPI Number	:	1215921374
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN TAKACS DO

Provider Business Mailing Address
First Line	:	5909 SE DIVISION ST
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97206-1470
Country	:	US
Telephone Number	:	503-234-1531
Fax Number	:	503-234-2367

Provider Business Practice Location Address
First Line	:	5909 SE DIVISION ST
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97206-1470
Country	:	US
Telephone Number	:	503-234-1531
Fax Number	:	503-234-2367

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

Provider Enumeration Date	:	09/06/2005
Last Update Date	:	08/18/2025

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Directions to “ JOHN TAKACS DO” Practice Location

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