Provider Demographics
NPI:1477544617
Name:JOSEPH A PARENT JR MD PC
Entity Type:Organization
Organization Name:JOSEPH A PARENT JR MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:A
Authorized Official - Last Name:PARENT
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:503-241-1992
Mailing Address - Street 1:PO BOX 8698
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97207-8698
Mailing Address - Country:US
Mailing Address - Phone:503-241-1992
Mailing Address - Fax:503-241-1977
Practice Address - Street 1:1750 SW HARBOR WAY
Practice Address - Street 2:SUITE 245
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97201-5128
Practice Address - Country:US
Practice Address - Phone:503-241-1992
Practice Address - Fax:503-241-1977
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-04
Last Update Date:2007-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR8183174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR235051Medicaid
ORR0000BHPWLMedicare PIN
ORC93478Medicare UPIN