Clifford Joe Anderson, MD
Individual provider Active NPI Allergy & Immunology Physician · Portland, OR
NPI 1013913409 · NPPES record last updated Aug 22, 2008
Key facts
- NPI
- 1013913409
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Allergy & Immunology Physician 207K00000X
- License
- MD09504 (OR)
- Practice address
- 233 NW 16TH Ave
Portland, OR 97209-2630 - Phone
- (503) 223-6480
- Fax
- (503) 294-1868
- NPI assigned
- Jun 22, 2005
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 3
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MD09504 | OR | MD | Clinical & Laboratory Immunology (Allergy & Immunology) Physician |
| MD00019556 | WA | MD | Clinical & Laboratory Immunology (Allergy & Immunology) Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Allergy Asthma & Dermatology Associates PC | Allergy & Immunology | Past |
Accepting new patients |
| Know Allergy LLC | Allergy | Past |
Accepting new patients |
| West Hills Allergy and Asthma Associates LLC | Allergy | Past |
Accepting new patients |
Interoperability endpoints
- https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Allergy & Immunology Physician | 207K00000X | MD09504 | OR | Yes |
| Allergy & Immunology Physician | 207K00000X | MD00019556 | WA | |
| Rheumatology Physician | 207RR0500X | MD09504 | OR | |
| Allergy Physician | 207KA0200X | MD09504 | OR | |
| Allergy Physician | 207KA0200X | MD00019556 | WA | |
| Clinical & Laboratory Immunology (Allergy & Immunology) Physician | 207KI0005X | MD09504 | OR | |
| Clinical & Laboratory Immunology (Allergy & Immunology) Physician | 207KI0005X | MD00019556 | WA |
Addresses
Primary practice location
233 NW 16TH Ave
Portland, OR 97209-2630
Mailing address
233 NW 16TH Ave
Portland, OR 97209-2630
Phone (503) 297-4779
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 004028 | Medicaid | OR |
Other providers in Portland, OR
- Christina Anderson
- Christina Heidi Anderson
- Christina L.M. Anderson
- Christine Anderson
- Christopher Laurence Anderson
- Connie J Anderson
- Corey Darryl Anderson
- Corey Dean Anderson
- Courtney Anderson
- Craig Anderson
All providers in Portland, OR · Allergy & Immunology Physician in Oregon
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 22, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.