Provider Demographics
NPI:1366445868
Name:ADAMSON, DARYL A (MD)
Entity Type:Individual
Prefix:DR
First Name:DARYL
Middle Name:A
Last Name:ADAMSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9400 SW BARNES RD
Mailing Address - Street 2:STE 307
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97225-6608
Mailing Address - Country:US
Mailing Address - Phone:503-797-6360
Mailing Address - Fax:503-292-0346
Practice Address - Street 1:9205 SW BARNES ROAD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97225
Practice Address - Country:US
Practice Address - Phone:503-216-2181
Practice Address - Fax:503-216-4850
Is Sole Proprietor?:No
Enumeration Date:2005-05-27
Last Update Date:2007-07-17
Deactivation Date:2006-03-17
Deactivation Code:
Reactivation Date:2006-04-04
Provider Licenses
StateLicense IDTaxonomies
OR12245174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR268193Medicaid
OR268193Medicaid
OR0000WCGDSBMedicare ID - Type Unspecified