Provider Demographics
NPI:1467573295
Name:OREGON FAMILY MEDICINE PC
Entity Type:Organization
Organization Name:OREGON FAMILY MEDICINE PC
Other - Org Name:E. KEONI ALEDO MD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ERENIO
Authorized Official - Middle Name:KEONI
Authorized Official - Last Name:ALEDO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:503-439-1539
Mailing Address - Street 1:1881 NW 185TH AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:ALOHA
Mailing Address - State:OR
Mailing Address - Zip Code:97006-6822
Mailing Address - Country:US
Mailing Address - Phone:503-439-1539
Mailing Address - Fax:503-439-8960
Practice Address - Street 1:1881 NW 185TH AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:ALOHA
Practice Address - State:OR
Practice Address - Zip Code:97006-6822
Practice Address - Country:US
Practice Address - Phone:503-439-1539
Practice Address - Fax:503-439-8960
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD25804207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORI38948Medicare UPIN