Provider Demographics
NPI:1861452765
Name:ACTON, JOSEPH HARCOURT (MD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:HARCOURT
Last Name:ACTON
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 3777
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97208-3777
Mailing Address - Country:US
Mailing Address - Phone:503-413-3900
Mailing Address - Fax:503-413-3710
Practice Address - Street 1:24800 SE STARK ST
Practice Address - Street 2:
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97030-3378
Practice Address - Country:US
Practice Address - Phone:503-413-8407
Practice Address - Fax:503-413-6951
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2020-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ31445207R00000X
AZ31447207R00000X
NMMD2010-0738207R00000X
ORMD153836207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ82677901Medicaid
AZAZ0743000OtherBC/BS OF AZ
AZP00089884OtherRR MEDICARE
IA71878OtherBCBS
AZZ76895Medicare ID - Type Unspecified
AZ102109Medicare PIN
IA71878OtherBCBS
AZAZ0743000OtherBC/BS OF AZ
AZH19189Medicare UPIN