Provider Demographics
NPI:1881097194
Name:REED DERMATOLOGY NORTHWEST LLC
Entity type:Organization
Organization Name:REED DERMATOLOGY NORTHWEST LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:HOOD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-542-0805
Mailing Address - Street 1:13305 NW CORNELL RD STE C
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97229-5987
Mailing Address - Country:US
Mailing Address - Phone:503-765-5000
Mailing Address - Fax:866-742-0249
Practice Address - Street 1:13305 NW CORNELL RD STE C
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97229-5987
Practice Address - Country:US
Practice Address - Phone:503-765-5000
Practice Address - Fax:866-742-0249
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-30
Last Update Date:2020-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD153328207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500678676Medicaid