Provider Demographics
NPI:1467565119
Name:SANDBERG, SCOTT ALAN (MD)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:ALAN
Last Name:SANDBERG
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 1:3500 N INTERSTATE AVE
Mailing Address - Street 2:DEPARTMENT OF RADIOLOGY
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97227-1196
Mailing Address - Country:US
Mailing Address - Phone:503-285-9321
Mailing Address - Fax:503-652-2880
Practice Address - Street 1:3500 N INTERSTATE AVE
Practice Address - Street 2:DEPARTMENT OF RADIOLOGY
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97227-1196
Practice Address - Country:US
Practice Address - Phone:503-285-9321
Practice Address - Fax:503-652-2880
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2022-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD000347142085R0202X
ORMD185142085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology