Provider Demographics
NPI:1831252782
Name:HOUGH, BRIAN S (MD)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:S
Last Name:HOUGH
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 1:5100 S MACADAM AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97239-3827
Mailing Address - Country:US
Mailing Address - Phone:971-202-5501
Mailing Address - Fax:971-228-2983
Practice Address - Street 1:5100 S MACADAM AVE STE 200
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239-3827
Practice Address - Country:US
Practice Address - Phone:971-202-5501
Practice Address - Fax:971-228-2983
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2021-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00033471207R00000X, 207RH0002X
ORMD198125207RH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0187377OtherLABOR AND INDUSTRIES
WA8398620Medicaid
F93206Medicare UPIN
WA8804741Medicare ID - Type Unspecified