NPI 1376571364

Northwest Dermatology & Laser Clinic PC

Organisation Dermatology Physician Portland, OR

Practice location

Address: 1130 NW 22nd Ave STE 330, Portland, OR 97210-2970
Phone: (503) 295-2366
Fax: (503) 295-3065
Mailing address: PO Box 23200, Portland, OR 97281-3200

Authorised official

Name: Bert G Tavelli
Title: President
Phone: (503) 295-2366

Registered specialties

Dermatology Physician Primary

Allopathic & Osteopathic Physicians Taxonomy 207N00000X Licence MD14681 (OR)

Other Dermatology providers in Oregon →

Registry record

NPI: 1376571364
Entity type: Organization
NPI issued: 29 Jun 2006
Record last updated: 1 Jun 2016

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.