MEDICARE: DR. KHALED RASHAD PHARAON 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	2086S0102X	Surgical Critical Care Physician	MD156740	OR
2	2086S0102X	Surgical Critical Care Physician	MD60365023	WA
3	2086S0127X	Trauma Surgery Physician	MD156740	OR
4	2086S0127X	Trauma Surgery Physician	MD60365023	WA
5	208600000X	Surgery Physician	MD156740	OR

General Provider Information

NPI Number	:	1902090061
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KHALED RASHAD PHARAON MD

Provider Business Mailing Address
First Line	:	505 NE 87TH AVE STE 301
Second Line	:
City	:	VANCOUVER
State	:	WA
Zip	:	98664-1965
Country	:	US
Telephone Number	:	360-514-1854
Fax Number	:	360-514-6063

Provider Business Practice Location Address
First Line	:	505 NE 87TH AVE
Second Line	:	SUITE 301
City	:	VANCOUVER
State	:	WA
Zip	:	98664-1989
Country	:	US
Telephone Number	:	360-514-1854
Fax Number	:	360-514-6063

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

Provider Enumeration Date	:	08/31/2007
Last Update Date	:	12/18/2025

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