Basic Information
| Provider Information | |||||||||
| NPI: | 1437280120 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CASCASDE OCCUPATIONAL MEDICINE PHYSICIANS INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1548 | ||||||||
| Address2: | |||||||||
| City: | LAKE OSWEGO | ||||||||
| State: | OR | ||||||||
| PostalCode: | 970350748 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5036351960 | ||||||||
| FaxNumber: | 5036358354 | ||||||||
| Practice Location | |||||||||
| Address1: | 4000 KRUSE WAY PL | ||||||||
| Address2: | BUILDING 2, SUITE 160 | ||||||||
| City: | LAKE OSWEGO | ||||||||
| State: | OR | ||||||||
| PostalCode: | 970355545 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5036351960 | ||||||||
| FaxNumber: | 5036358354 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/07/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | BRADDOCK | ||||||||
| AuthorizedOfficialFirstName: | JOHN | ||||||||
| AuthorizedOfficialMiddleName: | ROGERS | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO MEDICAL DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 5036351960 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QP2000X | X | Ambulatory Health Care Facilities | Clinic/Center | Physical Therapy | 261QX0100X | X | Ambulatory Health Care Facilities | Clinic/Center | Occupational Medicine |
No ID Information.