# BEAVERTON FAMILY MEDICINE

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1255607446
- **Authorized official:** KEITH HAINES (OWNER)
- **Authorized official phone:** (503) 213-3800

## Contact information

- **Practice address:** 17200 NW CORRIDOR CT, SUITE 110, BEAVERTON, OR 97006-3295
- **Practice address phone:** (503) 213-3800
- **Mailing address:** 17200 NW CORRIDOR CT, SUITE 110, BEAVERTON, OR 97006-3295
- **Mailing address phone:** (503) 213-3800

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 04/01/2012
- **Last updated:** 06/25/2012