Provider Demographics
NPI:1275791857
Name:CASCADE FOOT AND ANKLE SPECIALISTS, LLC
Entity Type:Organization
Organization Name:CASCADE FOOT AND ANKLE SPECIALISTS, LLC
Other - Org Name:CLIFFORD MAH, D.P.M.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DOCTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CLIFFORD
Authorized Official - Middle Name:D
Authorized Official - Last Name:MAH
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:503-643-1737
Mailing Address - Street 1:12400 NW CORNELL RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97229-5693
Mailing Address - Country:US
Mailing Address - Phone:503-643-1737
Mailing Address - Fax:503-643-4926
Practice Address - Street 1:12400 NW CORNELL RD
Practice Address - Street 2:SUITE 201
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97229-5693
Practice Address - Country:US
Practice Address - Phone:503-643-1737
Practice Address - Fax:503-643-4926
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-30
Last Update Date:2017-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDP00369213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty