Individual
HAYDEN T OLDHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
4805 NE GLISAN ST STE BG05, PORTLAND, OR 97213-2933
(503) 215-2392
Mailing address
PO BOX 3158, PORTLAND, OR 97208-3158
(503) 215-6494
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
MD188525
OR
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500688764
—
OR
Enumeration date
03/30/2015
Last updated
10/13/2020
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