Provider Demographics
NPI:1306472642
Name:HJORTH, PETER BOWEN III (PA-C, MPH)
Entity type:Individual
Prefix:MR
First Name:PETER
Middle Name:BOWEN
Last Name:HJORTH
Suffix:III
Gender:M
Credentials:PA-C, MPH
Other - Prefix:
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Mailing Address - Street 1:3181 SW SAM JACKSON PARK RD
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97239-3011
Mailing Address - Country:US
Mailing Address - Phone:503-494-7820
Mailing Address - Fax:503-494-7829
Practice Address - Street 1:200 NE MOTHER JOSEPH PL STE 320
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98664-3205
Practice Address - Country:US
Practice Address - Phone:360-514-6300
Practice Address - Fax:360-514-6301
Is Sole Proprietor?:No
Enumeration Date:2020-03-18
Last Update Date:2020-06-01
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
ORPA197800363AS0400X
WAPA61049844363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical