Individual
FARDOWSA SHARIFF IDRIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PHYSICIAN ASSISTANT
Contact information
Practice address
19255 SW 65TH AVE STE 200, TUALATIN, OR 97062-9712
(503) 828-1150
(503) 828-1160
Mailing address
19255 SW 65TH AVE STE 200, TUALATIN, OR 97062-9712
(503) 828-1150
(503) 828-1160
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
202128
OR
Other
Enumeration date
10/27/2019
Last updated
12/11/2020
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