Provider Demographics
NPI:1073167730
Name:OREGON ADULT MEDICINE PC
Entity Type:Organization
Organization Name:OREGON ADULT MEDICINE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RIYAD
Authorized Official - Middle Name:
Authorized Official - Last Name:FARES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:503-405-3042
Mailing Address - Street 1:2330 NW FLANDERS ST STE 201
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97210-3460
Mailing Address - Country:US
Mailing Address - Phone:714-571-5000
Mailing Address - Fax:
Practice Address - Street 1:2330 NW FLANDERS ST STE 201
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97210-3460
Practice Address - Country:US
Practice Address - Phone:503-405-3042
Practice Address - Fax:503-717-9969
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-30
Last Update Date:2020-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty