Provider Demographics
NPI:1255680054
Name:NW NEUROPHYSIOLOGY CONSULTANTS
Entity Type:Organization
Organization Name:NW NEUROPHYSIOLOGY CONSULTANTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:DEMPSTER
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:503-724-9725
Mailing Address - Street 1:7734 N FOWLER AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97217-5931
Mailing Address - Country:US
Mailing Address - Phone:503-724-9725
Mailing Address - Fax:
Practice Address - Street 1:7734 N FOWLER AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97217-5931
Practice Address - Country:US
Practice Address - Phone:503-724-9725
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-07
Last Update Date:2012-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD601709892084N0600X
ORMD283042084N0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical NeurophysiologyGroup - Single Specialty