Provider Demographics
NPI:1912103367
Name:OREGON FOOT AND ANKLE SPECIALISTS, LLC
Entity Type:Organization
Organization Name:OREGON FOOT AND ANKLE SPECIALISTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:G
Authorized Official - Last Name:ORAHOOD
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:503-292-9252
Mailing Address - Street 1:17200 NW CORRIDOR CT STE 108
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97006-3295
Mailing Address - Country:US
Mailing Address - Phone:503-292-9252
Mailing Address - Fax:503-992-6780
Practice Address - Street 1:17200 NW CORRIDOR CT STE 108
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97006-3295
Practice Address - Country:US
Practice Address - Phone:503-292-9252
Practice Address - Fax:503-992-6780
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-22
Last Update Date:2016-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD9000164213ES0103X
332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR157652OtherUPIN
ORT19299Medicare UPIN
OR0427310001Medicare NSC