Provider Demographics
NPI:1952413395
Name:CHAD T. PFEFER, MD, PC
Entity Type:Organization
Organization Name:CHAD T. PFEFER, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHAD
Authorized Official - Middle Name:T
Authorized Official - Last Name:PFEFER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:503-640-1450
Mailing Address - Street 1:545 SE OAK ST STE A
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97123-4147
Mailing Address - Country:US
Mailing Address - Phone:503-640-1450
Mailing Address - Fax:503-640-2814
Practice Address - Street 1:545 SE OAK ST STE A
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97123-4147
Practice Address - Country:US
Practice Address - Phone:503-640-1450
Practice Address - Fax:503-640-2814
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2012-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD21275207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR288502Medicaid
ORR117300Medicare PIN
ORH12507Medicare UPIN