Provider Demographics
NPI:1427304864
Name:DEGROOT, MARTIN G (PA-C)
Entity type:Individual
Prefix:
First Name:MARTIN
Middle Name:G
Last Name:DEGROOT
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17200 NW CORRIDOR CT
Mailing Address - Street 2:SUITE 105
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97006-3295
Mailing Address - Country:US
Mailing Address - Phone:503-614-8400
Mailing Address - Fax:
Practice Address - Street 1:17200 NW CORRIDOR CT
Practice Address - Street 2:SUITE 105
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97006-3295
Practice Address - Country:US
Practice Address - Phone:503-614-8400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-02
Last Update Date:2012-08-02
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant