Individual
GARY W TAKAHASHI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
15700 SW GREYSTONE COURT, BEAVERTON, OR 97006-6011
(503) 203-1000
(503) 203-1010
Mailing address
PO BOX 3378, PORTLAND, OR 97208-3378
(503) 203-1000
(503) 203-1010
Taxonomy
Speciality
Code
Description
License number
State
207RH0003X
Hematology & Oncology Physician
Primary
MD14500
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00WFBBCC
MEDICARE ID
OR
05
—
54853
—
OR
01
—
CV0082
RR MEDICARE GROUP NUMBER
OR
Enumeration date
05/27/2005
Last updated
10/17/2007
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