Provider Demographics
NPI:1295737997
Name:BEYER, SCOTT PRESTON (PA-C)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:PRESTON
Last Name:BEYER
Suffix:
Gender:M
Credentials:PA-C
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 1:2222 NW LOVEJOY ST STE 419
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97210-5102
Practice Address - Country:US
Practice Address - Phone:503-413-4488
Practice Address - Fax:503-413-1812
Is Sole Proprietor?:No
Enumeration Date:2005-08-11
Last Update Date:2019-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORPA00390363AS0400X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500605499Medicaid
OR106490Medicare PIN
OR970017816Medicare PIN
OR500605499Medicaid