Provider Demographics
NPI:1831296367
Name:DARDIS, PAGE Y (MD)
Entity Type:Individual
Prefix:DR
First Name:PAGE
Middle Name:Y
Last Name:DARDIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:PAGE
Other - Middle Name:Y
Other - Last Name:KOUDELE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:16264 SW 104TH AVE
Mailing Address - Street 2:
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97224-4597
Mailing Address - Country:US
Mailing Address - Phone:503-684-9734
Mailing Address - Fax:503-684-9734
Practice Address - Street 1:4855 SW WESTERN AVE
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97005-3460
Practice Address - Country:US
Practice Address - Phone:503-643-7565
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD21137207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine