Provider Demographics
NPI:1649351990
Name:UNGER, PHILLIP STEPHEN (MD)
Entity type:Individual
Prefix:DR
First Name:PHILLIP
Middle Name:STEPHEN
Last Name:UNGER
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 1:9155 SW BARNES RD
Mailing Address - Street 2:SUITE #733
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97225-6625
Mailing Address - Country:US
Mailing Address - Phone:509-292-5454
Mailing Address - Fax:503-297-4299
Practice Address - Street 1:9155 SW BARNES RD
Practice Address - Street 2:SUITE #733
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97225-6625
Practice Address - Country:US
Practice Address - Phone:509-292-5454
Practice Address - Fax:503-297-4299
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD08604261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR108710Medicare ID - Type UnspecifiedMEDICARE B PROVIDER NUMBE
ORC93981Medicare UPIN