Provider Demographics
NPI:1780855270
Name:AKOTS AND FREDERICK PC
Entity Type:Organization
Organization Name:AKOTS AND FREDERICK PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:NORMUND
Authorized Official - Middle Name:JURIS
Authorized Official - Last Name:AKOTS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:503-292-9183
Mailing Address - Street 1:10200 SW EASTRIDGE ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97225-5064
Mailing Address - Country:US
Mailing Address - Phone:503-292-9183
Mailing Address - Fax:503-292-9280
Practice Address - Street 1:10200 SW EASTRIDGE ST
Practice Address - Street 2:SUITE 101
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97225-5064
Practice Address - Country:US
Practice Address - Phone:503-292-9183
Practice Address - Fax:503-292-9280
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-12
Last Update Date:2010-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR118222Medicare PIN