Provider Demographics
NPI:1114079472
Name:ENGLANDER, WAYNE DOUGLAS (MD)
Entity Type:Individual
Prefix:DR
First Name:WAYNE
Middle Name:DOUGLAS
Last Name:ENGLANDER
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:421 SW OAK ST
Mailing Address - Street 2:210
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97204-1817
Mailing Address - Country:US
Mailing Address - Phone:503-988-3674
Mailing Address - Fax:503-988-4144
Practice Address - Street 1:426 SW STARK ST
Practice Address - Street 2:8TH FLOOR
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97204-2347
Practice Address - Country:US
Practice Address - Phone:503-988-3674
Practice Address - Fax:503-988-4144
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2009-12-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
ORMD18961207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORG26288Medicare UPIN
OR105232Medicare ID - Type Unspecified