MEDICARE: DR. JOHN OPPENHEIMER 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	207R00000X	Internal Medicine Physician	036058549	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	143442	OTHER	IHS
3	98999	OTHER	BCWELLMARK 7TH ST
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	98986	OTHER	BCWELLMARK WEST
8	IL0182	OTHER	JOHN DEERE
9	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1922071513
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN OPPENHEIMER MD

Provider Business Mailing Address
First Line	:	1130 NW 22ND AVE #220
Second Line	:	LEGACY CLINIC NORTHWEST
City	:	PORTLAND
State	:	OR
Zip	:	97210-3025
Country	:	US
Telephone Number	:	503-413-8988
Fax Number	:	503-274-4815

Provider Business Practice Location Address
First Line	:	1130 NW 22ND AVE #220
Second Line	:	LEGACY CLINIC NORTHWEST
City	:	PORTLAND
State	:	OR
Zip	:	97210-3025
Country	:	US
Telephone Number	:	503-413-8988
Fax Number	:	503-274-4815

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

Provider Enumeration Date	:	02/13/2006
Last Update Date	:	02/24/2011

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Directions to “ DR. JOHN OPPENHEIMER MD” Practice Location

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