MEDICARE: BENJAMIN DAVID EHST M.D., PH.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	207N00000X	Dermatology Physician	MD27612	OR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	220415	OTHER	MD	JOHNS HOPKINS ID

General Provider Information

NPI Number	:	1740320068
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BENJAMIN DAVID EHST M.D., PH.D.

Provider Business Mailing Address
First Line	:	9495 SW LOCUST ST STE A
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97223-6683
Country	:	US
Telephone Number	:	36-369-0115
Fax Number	:

Provider Business Practice Location Address
First Line	:	9495 SW LOCUST ST STE A
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97223-6683
Country	:	US
Telephone Number	:	36-369-0115
Fax Number	:

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

Provider Enumeration Date	:	02/07/2007
Last Update Date	:	06/03/2019

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