Provider Demographics
NPI:1235131624
Name:MOSHOFSKY, DEAN A (MD)
Entity Type:Individual
Prefix:
First Name:DEAN
Middle Name:A
Last Name:MOSHOFSKY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15455 NW GREENBRIER PKWY
Mailing Address - Street 2:STE 112
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97006-7374
Mailing Address - Country:US
Mailing Address - Phone:503-466-1668
Mailing Address - Fax:503-439-6194
Practice Address - Street 1:15455 NW GREENBRIER PKWY
Practice Address - Street 2:STE 111
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97006-7374
Practice Address - Country:US
Practice Address - Phone:503-534-3434
Practice Address - Fax:503-645-4544
Is Sole Proprietor?:No
Enumeration Date:2005-08-15
Last Update Date:2013-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD13916208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR101907Medicaid
OR101907Medicaid
OR105281Medicare ID - Type Unspecified