Provider Demographics
NPI:1275649162
Name:PATILLO, DOMINIC PATRICK (MD)
Entity type:Individual
Prefix:DR
First Name:DOMINIC
Middle Name:PATRICK
Last Name:PATILLO
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Gender:M
Credentials:MD
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Mailing Address - Street 1:17355 LOWER BOONES FERRY RD
Mailing Address - Street 2:STE 100A
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97035-2839
Mailing Address - Country:US
Mailing Address - Phone:503-256-5866
Mailing Address - Fax:503-254-0656
Practice Address - Street 1:17355 LOWER BOONES FERRY RD
Practice Address - Street 2:STE 100A
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97035-2839
Practice Address - Country:US
Practice Address - Phone:503-256-5866
Practice Address - Fax:503-254-0656
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2025-08-25
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Provider Licenses
StateLicense IDTaxonomies
ORMD151644207XS0106X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery