Provider Demographics
NPI:1588966857
Name:WEST PORTLAND NEUROLOGY, L.L.C.
Entity type:Organization
Organization Name:WEST PORTLAND NEUROLOGY, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/NEUROLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:JOSIAH
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PHD
Authorized Official - Phone:503-954-1566
Mailing Address - Street 1:1040 NW 22ND AVE
Mailing Address - Street 2:SUITE 630
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97210-3057
Mailing Address - Country:US
Mailing Address - Phone:503-954-1566
Mailing Address - Fax:503-796-2742
Practice Address - Street 1:1040 NW 22ND AVE
Practice Address - Street 2:SUITE 630
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97210-3057
Practice Address - Country:US
Practice Address - Phone:503-954-1566
Practice Address - Fax:503-796-2742
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-18
Last Update Date:2011-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1017284Medicaid
OR012360000OtherREGENCE BLUE CROSS
OR025671Medicaid
WA1017284Medicaid