Provider Demographics
NPI:1285854844
Name:MILLAN, PATRICIA EDEN FERNANDEZ (MD)
Entity Type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:EDEN FERNANDEZ
Last Name:MILLAN
Suffix:
Gender:F
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:PO BOX 3158
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97208-3158
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:16770 SW EDY RD
Practice Address - Street 2:SUITE 102
Practice Address - City:SHERWOOD
Practice Address - State:OR
Practice Address - Zip Code:97140-9678
Practice Address - Country:US
Practice Address - Phone:503-216-9600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2020-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ41622207Q00000X
ORMD170193207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500678492Medicaid
ORP014383736OtherRR MEDICARE (PH&S)
ORR178398Medicare PIN