Provider Demographics
NPI:1326032459
Name:PHINNEY, EDWARD S JR (MD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:S
Last Name:PHINNEY
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:3439 NE SANDY BLVD
Mailing Address - Street 2:PMB 375
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97232-1959
Mailing Address - Country:US
Mailing Address - Phone:503-284-8841
Mailing Address - Fax:503-282-3302
Practice Address - Street 1:9155 SW BARNES RD
Practice Address - Street 2:STE 217
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97225-6625
Practice Address - Country:US
Practice Address - Phone:503-297-1548
Practice Address - Fax:503-297-0230
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-02
Last Update Date:2007-10-11
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Provider Licenses
StateLicense IDTaxonomies
ORMD13227208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR178269Medicaid
ORC91923Medicare UPIN
ORR113021Medicare PIN