Active NPI
Alexander Herman Lau, M.D.
- Pediatrics Physician
- Gresham, OR
National Provider Identifier
1255764379
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- MD174807
- Practice address
- 25050 SE Stark St
Ste 300
Gresham, OR 97030-3383 - Phone
- (503) 667-8878
- Fax
- (503) 667-0310
- NPI assigned
- Aug 13, 2013
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | MD174807 | OR | Primary |
Addresses
Primary practice location
25050 SE Stark St
Ste 300
Gresham, OR 97030-3383
Mailing address
25050 SE Stark St
Ste 300
Gresham, OR 97030-3383
Phone (503) 667-8878
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 500704124 | Medicaid | OR |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MD174807 | OR | MD | Pediatrics Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Metropolitan Pediatrics, LLC | Pediatrics | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Pediatrics Physician
- Portland, OR
- NPI 1235131632
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1376352000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1469145600000",
"number": "1255764379",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "25050 SE STARK ST",
"address_2": "STE 300",
"city": "GRESHAM",
"state": "OR",
"postal_code": "970303383",
"telephone_number": "503-667-8878",
"fax_number": "503-667-0310"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "25050 SE STARK ST",
"address_2": "STE 300",
"city": "GRESHAM",
"state": "OR",
"postal_code": "970303383",
"telephone_number": "503-667-8878",
"fax_number": "503-667-0310"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LAU",
"first_name": "ALEXANDER",
"middle_name": "HERMAN",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2013-08-13",
"last_updated": "2016-07-22",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "OR",
"license": "MD174807",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "500704124",
"state": "OR"
}
],
"endpoints": [],
"other_names": []
}Other providers in Gresham, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 22, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.