Basic Information
| Provider Information | |||||||||
| NPI: | 1083637268 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SPERLIN | ||||||||
| FirstName: | ANDREW | ||||||||
| MiddleName: | GORDON | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5100 SW MACADAM AVE | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972396102 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9712025500 | ||||||||
| FaxNumber: | 9712025555 | ||||||||
| Practice Location | |||||||||
| Address1: | 5100 SW MACADAM AVE | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972396102 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9712025500 | ||||||||
| FaxNumber: | 9712025555 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/26/2006 | ||||||||
| LastUpdateDate: | 01/24/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | MD20921 | OR | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 170342 | 05 | OR | MEDICAID |