Provider Demographics
NPI:1770672149
Name:SCHENK, JOHN FREDERICK (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:FREDERICK
Last Name:SCHENK
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 1:11010 SW MOREY CT
Mailing Address - Street 2:
Mailing Address - City:WILSONVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97070-7590
Mailing Address - Country:US
Mailing Address - Phone:503-682-1571
Mailing Address - Fax:503-682-1571
Practice Address - Street 1:11010 SW MOREY CT
Practice Address - Street 2:
Practice Address - City:WILSONVILLE
Practice Address - State:OR
Practice Address - Zip Code:97070-7590
Practice Address - Country:US
Practice Address - Phone:503-682-1571
Practice Address - Fax:503-682-1571
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2007-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD 8935207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1099340Medicaid
OR213926Medicaid
ORA15049Medicare UPIN
ORR0000BLBVKMedicare PIN
OR213926Medicaid