Provider Demographics
NPI:1689627135
Name:FROMHERZ, SCOTT D (MD)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:D
Last Name:FROMHERZ
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 1:7450 SW BEVELAND ST
Mailing Address - Street 2:STE 120
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97223
Mailing Address - Country:US
Mailing Address - Phone:503-639-7000
Mailing Address - Fax:503-639-7006
Practice Address - Street 1:7450 SW BEVELAND ST
Practice Address - Street 2:STE 120
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97223
Practice Address - Country:US
Practice Address - Phone:503-639-7000
Practice Address - Fax:503-639-7006
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-18
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD260062084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR269961Medicaid
ORI41129Medicare UPIN
OR269961Medicaid
ORR133625Medicare PIN