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1902819451

NPI Code Detail

MEDICARE: DR. CHARLES TANNERT PINNEY JR. M.D.

MEDICARE: DR. CHARLES TANNERT PINNEY JR. M.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	207P00000X	Emergency Medicine Physician	OR MD 15755	OR
2	207P00000X	Emergency Medicine Physician	MD00035841	WA
3	208D00000X	General Practice Physician	MD00035841	WA
4	207PE0004X	Emergency Medical Services (Emergency Medicine) Physician	MD00035841	WA
5	207Q00000X	Family Medicine Physician	MD00035841	WA
6	207P00000X	Emergency Medicine Physician	WA MD00035841	WA

General Provider Information

NPI Number	:	1902819451
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHARLES TANNERT PINNEY JR. M.D.

Provider Business Mailing Address
First Line	:	500 NE MULTNOMAH ST STE 100
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97232-2031
Country	:	US
Telephone Number	:	503-813-3850
Fax Number	:

Provider Business Practice Location Address
First Line	:	12607 SE MILL PLAIN BLVD
Second Line	:
City	:	VANCOUVER
State	:	WA
Zip	:	98684-6055
Country	:	US
Telephone Number	:	800-813-2000
Fax Number	:

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

Provider Enumeration Date	:	08/15/2006
Last Update Date	:	10/06/2022

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Directions to “ DR. CHARLES TANNERT PINNEY JR. M.D.” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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