Provider Demographics
NPI:1780796326
Name:MAKSIMOV, OLEG (MD)
Entity type:Individual
Prefix:
First Name:OLEG
Middle Name:
Last Name:MAKSIMOV
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 1:689 NW BURNSIDE RD FL 1
Mailing Address - Street 2:
Mailing Address - City:GRESHAM
Mailing Address - State:OR
Mailing Address - Zip Code:97030-3739
Mailing Address - Country:US
Mailing Address - Phone:503-382-8106
Mailing Address - Fax:503-382-8100
Practice Address - Street 1:689 NW BURNSIDE RD FL 2
Practice Address - Street 2:
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97030-3739
Practice Address - Country:US
Practice Address - Phone:503-382-8106
Practice Address - Fax:503-382-8100
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2021-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD431737208100000X
ORMD285262081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation