Individual
DR. JOHN OPPENHEIMER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1130 NW 22ND AVE #220, LEGACY CLINIC NORTHWEST, PORTLAND, OR 97210-3025
(503) 413-8988
(503) 274-4815
Mailing address
1130 NW 22ND AVE #220, LEGACY CLINIC NORTHWEST, PORTLAND, OR 97210-3025
(503) 413-8988
(503) 274-4815
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
036058549
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036058549002
—
IL
05
—
0571232
—
IA
01
—
143442
IHS
—
05
—
1571232
—
IA
05
—
273137
—
OR
05
—
8497364
—
WA
01
—
98986
BCWELLMARK WEST
—
01
—
98999
BCWELLMARK 7TH ST
—
01
—
IL0182
JOHN DEERE
—
Enumeration date
02/13/2006
Last updated
02/24/2011
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