Provider Demographics
NPI:1083701833
Name:TORKELSON, EDMUND HOWARD (DO)
Entity Type:Individual
Prefix:DR
First Name:EDMUND
Middle Name:HOWARD
Last Name:TORKELSON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1960 NW 167TH PL
Mailing Address - Street 2:SUITE #204
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97006-4803
Mailing Address - Country:US
Mailing Address - Phone:503-614-8735
Mailing Address - Fax:503-614-8749
Practice Address - Street 1:1960 NW 167TH PL
Practice Address - Street 2:SUITE #204
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97006-4803
Practice Address - Country:US
Practice Address - Phone:503-614-8735
Practice Address - Fax:503-614-8749
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDO18551207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR080676Medicaid
OR100553Medicare ID - Type Unspecified
ORG28200Medicare UPIN