Provider Demographics
NPI:1881751071
Name:PICKERING, PAUL DOUGLAS (MD)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:DOUGLAS
Last Name:PICKERING
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 1:7650 SW BEVELAND STREET
Mailing Address - Street 2:SUITE 200
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97223
Mailing Address - Country:US
Mailing Address - Phone:503-601-3615
Mailing Address - Fax:503-840-3299
Practice Address - Street 1:7431 NE EVERGREEN PKWY STE 100
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97124-5831
Practice Address - Country:US
Practice Address - Phone:503-840-3400
Practice Address - Fax:503-840-3409
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD175483207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500696398Medicaid
IA0475905Medicaid
IAI16357Medicare PIN
OR500696398Medicaid