Provider Demographics
NPI:1245419969
Name:PORTLAND OTOLOGIC CLINIC PC
Entity Type:Organization
Organization Name:PORTLAND OTOLOGIC CLINIC PC
Other - Org Name:JOHN M EPLEY MD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:MACNAUGHTON
Authorized Official - Last Name:EPLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:503-233-5925
Mailing Address - Street 1:545 NE 47TH AVE STE 212
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97213-2237
Mailing Address - Country:US
Mailing Address - Phone:503-233-5925
Mailing Address - Fax:
Practice Address - Street 1:545 NE 47TH AVE STE 212
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97213-2237
Practice Address - Country:US
Practice Address - Phone:503-233-5925
Practice Address - Fax:503-233-6140
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-30
Last Update Date:2007-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD06685207YX0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YX0901XAllopathic & Osteopathic PhysiciansOtolaryngologyOtology & NeurotologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR027713Medicaid
ORC92587Medicare UPIN
OR027713Medicaid