MEDICARE: DR. DOMINIC PATRICK PATILLO MD

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	207XS0106X	Orthopaedic Hand Surgery Physician	MD151644	OR
2	207X00000X	Orthopaedic Surgery Physician	MD151644	OR

General Provider Information

NPI Number	:	1275649162
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DOMINIC PATRICK PATILLO MD

Provider Business Mailing Address
First Line	:	17355 LOWER BOONES FERRY RD
Second Line	:	STE 100A
City	:	LAKE OSWEGO
State	:	OR
Zip	:	97035-2839
Country	:	US
Telephone Number	:	503-256-5866
Fax Number	:	503-254-0656

Provider Business Practice Location Address
First Line	:	17355 LOWER BOONES FERRY RD
Second Line	:	STE 100A
City	:	LAKE OSWEGO
State	:	OR
Zip	:	97035-2839
Country	:	US
Telephone Number	:	503-256-5866
Fax Number	:	503-254-0656

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

Provider Enumeration Date	:	08/22/2006
Last Update Date	:	08/25/2025

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