Provider Demographics
NPI:1285834135
Name:EAST PORTLAND NEUROLOGY CLINIC PC
Entity Type:Organization
Organization Name:EAST PORTLAND NEUROLOGY CLINIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:HOWARD
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:503-256-3034
Mailing Address - Street 1:10101 SE MAIN ST
Mailing Address - Street 2:SUITE 2004
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97216-2468
Mailing Address - Country:US
Mailing Address - Phone:503-256-3034
Mailing Address - Fax:503-256-3055
Practice Address - Street 1:10101 SE MAIN ST
Practice Address - Street 2:SUITE 2004
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97216-2468
Practice Address - Country:US
Practice Address - Phone:503-256-3034
Practice Address - Fax:503-256-3055
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-19
Last Update Date:2023-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR268003Medicaid
OR268003Medicaid