MEDICARE: MR. COLIN STORZ PA-C

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	363AM0700X	Medical Physician Assistant	165805	OR

General Provider Information

NPI Number	:	1871982975
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. COLIN STORZ PA-C

Provider Business Mailing Address
First Line	:	3623 N BORTHWICK AVE
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97227-1218
Country	:	US
Telephone Number	:	503-846-6352
Fax Number	:

Provider Business Practice Location Address
First Line	:	3623 N BORTHWICK AVE
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97227-1218
Country	:	US
Telephone Number	:	503-846-6352
Fax Number	:

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

Provider Enumeration Date	:	01/13/2015
Last Update Date	:	01/13/2015

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Directions to “ MR. COLIN STORZ PA-C” Practice Location

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