MEDICARE: NORTHWEST UROLOGICAL CLINIC PC

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	174400000X	Specialist

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	:	1619995172
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTHWEST UROLOGICAL CLINIC PC

Provider Business Mailing Address
First Line	:	2230 NW PETTYGROVE ST
Second Line	:	SUITE 210
City	:	PORTLAND
State	:	OR
Zip	:	97210-2659
Country	:	US
Telephone Number	:	503-223-6223
Fax Number	:	503-223-3665

Provider Business Practice Location Address
First Line	:	2230 NW PETTYGROVE ST
Second Line	:	SUITE 210
City	:	PORTLAND
State	:	OR
Zip	:	97210-2659
Country	:	US
Telephone Number	:	503-223-6223
Fax Number	:	503-223-3665

Authorized Official
Title or Position	:	PARTNER
Name	:	DR. DAVID BRIAN LASHLEY
Credential	:
Telephone Number	:	503-223-6223

Provider Enumeration Date	:	07/17/2006
Last Update Date	:	03/02/2010

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Directions to “NORTHWEST UROLOGICAL CLINIC PC ” Practice Location

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