Basic Information
| Provider Information | |||||||||
| NPI: | 1699752899 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | UROLOGIC CONSULTANTS PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9135 SW BARNES RD | ||||||||
| Address2: | SUITE 663 | ||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972256601 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5032971078 | ||||||||
| FaxNumber: | 5032922176 | ||||||||
| Practice Location | |||||||||
| Address1: | 9135 SW BARNES RD | ||||||||
| Address2: | SUITE 663 | ||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972256601 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5032971078 | ||||||||
| FaxNumber: | 5032922176 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/28/2005 | ||||||||
| LastUpdateDate: | 08/18/2008 | ||||||||
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| AuthorizedOfficialLastName: | SHAFFER | ||||||||
| AuthorizedOfficialFirstName: | BRIAN | ||||||||
| AuthorizedOfficialMiddleName: | SCOTT | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 5032971078 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208800000X | MD18741 | OR | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Urology | 208800000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Urology |
No ID Information.