Provider Demographics
NPI:1801878251
Name:LINDGREN, JOHN ARTHUR (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:ARTHUR
Last Name:LINDGREN
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:STE 401
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97225-6625
Mailing Address - Country:US
Mailing Address - Phone:503-297-1542
Mailing Address - Fax:503-297-5763
Practice Address - Street 1:9155 SW BARNES RD
Practice Address - Street 2:STE 401
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97225-6625
Practice Address - Country:US
Practice Address - Phone:503-297-1542
Practice Address - Fax:503-297-5763
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-18
Last Update Date:2010-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD08286207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR111682Medicaid
OR0000BHGRSMedicare ID - Type Unspecified
OR111682Medicaid