Provider Demographics
NPI:1386640688
Name:ALEXANDER, PHILIP T (MD)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:T
Last Name:ALEXANDER
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 1:9701 SW BARNES RD #140
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97225-9149
Mailing Address - Country:US
Mailing Address - Phone:503-292-9565
Mailing Address - Fax:503-292-9478
Practice Address - Street 1:9701 SW BARNES RD
Practice Address - Street 2:STE 140
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97225
Practice Address - Country:US
Practice Address - Phone:503-292-9565
Practice Address - Fax:503-292-9478
Is Sole Proprietor?:No
Enumeration Date:2005-06-22
Last Update Date:2009-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR136482086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR000229Medicaid
ORC94222Medicare UPIN
OR000229Medicaid