Provider Demographics
NPI:1275299166
Name:FUKUDA, TOSHINORI (MD)
Entity Type:Individual
Prefix:MR
First Name:TOSHINORI
Middle Name:
Last Name:FUKUDA
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:OHSU DIAGNOSTIC RADIOLOGY L340
Mailing Address - Street 2:3181 SW SAM JACKSON PARK ROAD
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97239
Mailing Address - Country:US
Mailing Address - Phone:503-494-4511
Mailing Address - Fax:
Practice Address - Street 1:OHSU DIAGNOSTIC RADIOLOGY L340
Practice Address - Street 2:3181 SW SAM JACKSON PARK ROAD
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239
Practice Address - Country:US
Practice Address - Phone:503-494-4511
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-15
Last Update Date:2021-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORPG2041522085N0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiologyGroup - Single Specialty