Individual
ANDRIS ANTONISKIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
5228 NE HOYT ST, BLDG B, 3RD FLOOR, PORTLAND, OR 97213-3055
(503) 215-2584
(503) 215-1524
Mailing address
PO BOX 3158, PORTLAND, OR 97208-3158
(503) 215-6494
(503) 215-6644
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
MD10115
OR
207RA0401X
Addiction Medicine (Internal Medicine) Physician
MD10115
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
220376
—
OR
05
—
500626738
—
OR
Enumeration date
07/19/2005
Last updated
11/07/2014
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