Provider Demographics
NPI:1255678439
Name:ANANYEV, DANIEL ALEXANDER (DO)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:ALEXANDER
Last Name:ANANYEV
Suffix:
Gender:M
Credentials:DO
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 4037
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97208-4037
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:541-708-5934
Practice Address - Street 1:16463 BOONES FERRY RD STE 300
Practice Address - Street 2:
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97035-4376
Practice Address - Country:US
Practice Address - Phone:503-658-9351
Practice Address - Fax:541-708-5934
Is Sole Proprietor?:No
Enumeration Date:2013-01-09
Last Update Date:2025-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDO166843207Q00000X
CA20A12556207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine