Provider Demographics
NPI:1134100498
Name:AMBIEL, PATRICK A (PA)
Entity type:Individual
Prefix:
First Name:PATRICK
Middle Name:A
Last Name:AMBIEL
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:275 MCCLURE AVE
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:OR
Mailing Address - Zip Code:97103-5514
Mailing Address - Country:US
Mailing Address - Phone:503-368-5286
Mailing Address - Fax:
Practice Address - Street 1:1960 NW 167TH PL
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97006-4804
Practice Address - Country:US
Practice Address - Phone:503-629-7500
Practice Address - Fax:503-629-7505
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORPA00045363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR132769Medicare ID - Type Unspecified
ORR08529Medicare UPIN