Basic Information
| Provider Information | |||||||||
| NPI: | 1508857657 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PORTLAND FAMILY PRACTICE INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 541 NE 20TH AVE | ||||||||
| Address2: | SUITE 210 | ||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972322862 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5032336940 | ||||||||
| FaxNumber: | 5032362676 | ||||||||
| Practice Location | |||||||||
| Address1: | 541 NE 20TH AVE | ||||||||
| Address2: | SUITE 210 | ||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972322862 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5032336940 | ||||||||
| FaxNumber: | 5032362676 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/28/2005 | ||||||||
| LastUpdateDate: | 01/27/2011 | ||||||||
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| AuthorizedOfficialLastName: | UPHOFF | ||||||||
| AuthorizedOfficialFirstName: | EUGENE | ||||||||
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| AuthorizedOfficialTitleorPosition: | PHYSICIAN | ||||||||
| AuthorizedOfficialTelephone: | 5032336940 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 358997 | OR | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.