Provider Demographics
NPI:1851311088
Name:ADLER, DAVID ELLIOTT (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:ELLIOTT
Last Name:ADLER
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:PO BOX 23200
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97281-3200
Mailing Address - Country:US
Mailing Address - Phone:503-796-2743
Mailing Address - Fax:503-796-2742
Practice Address - Street 1:1040 NW 22ND AVE
Practice Address - Street 2:SUITE 630
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97210-3057
Practice Address - Country:US
Practice Address - Phone:503-796-2743
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2009-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD21940207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR134312Medicaid
WA1118454Medicaid
R112832Medicare PIN
OR134312Medicaid
ORR112832Medicare PIN
WA1118454Medicaid