Organization
PACIFIC NORTHWEST HAIR RESTORATION
Active
Parent organization
FOUNTAIN OF YOUTH, LLC
Organization subpart
Yes
Provider details
NPI number
Legal business name
FOUNTAIN OF YOUTH, LLC
Authorized official
DR. ANDREW PATRICK HIGGINS MD (OWNER/PROVIDER)
(541) 480-6612
Entity
Organization
Contact information
Practice address
9735 SW SHADY LN STE 200, TIGARD, OR 97223-5481
(503) 941-5029
(503) 941-5029
Mailing address
2450 NE MARY ROSE PL STE 205, BEND, OR 97701-7132
(541) 749-7000
(541) 749-7005
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
—
—
Other
Enumeration date
06/26/2026
Last updated
06/26/2026
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