Provider Demographics
NPI:1033143748
Name:ERIK K SZETO DO PC
Entity Type:Organization
Organization Name:ERIK K SZETO DO PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OF THE CORPORATION
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIK
Authorized Official - Middle Name:K
Authorized Official - Last Name:SZETO
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:503-239-5836
Mailing Address - Street 1:4130 SE DIVISION STREET
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97202
Mailing Address - Country:US
Mailing Address - Phone:503-239-5836
Mailing Address - Fax:503-236-8326
Practice Address - Street 1:4130 SE DIVISION STREET
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97202
Practice Address - Country:US
Practice Address - Phone:503-239-5836
Practice Address - Fax:503-236-8326
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORORDO11884207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR217497Medicaid
OR217497Medicaid
C90907Medicare UPIN