Provider Demographics
NPI:1578923751
Name:PDXENT AND AUDIOLOGY MEDICAL GROUP PC
Entity Type:Organization
Organization Name:PDXENT AND AUDIOLOGY MEDICAL GROUP PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MAXWELL
Authorized Official - Middle Name:C
Authorized Official - Last Name:FURR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:503-222-3638
Mailing Address - Street 1:2222 NW LOVEJOY ST
Mailing Address - Street 2:607
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97210-3033
Mailing Address - Country:US
Mailing Address - Phone:503-222-3638
Mailing Address - Fax:503-223-5139
Practice Address - Street 1:2222 NW LOVEJOY ST
Practice Address - Street 2:607
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97210-3033
Practice Address - Country:US
Practice Address - Phone:503-222-3638
Practice Address - Fax:503-223-5139
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-01
Last Update Date:2023-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500647076Medicaid