Frederick T Waller MD PC

Primary specialty

Neurological Surgery PhysicianTaxonomy code 207T00000X

License

MD08927 Issued in OR

Legal business name

FREDERICK T WALLER MD PC

Practice address

9155 SW Barnes Rd Ste 211
Portland, OR 97225-6629

Phone

(503) 520-1260

Fax

(503) 469-9176

NPI assigned

Jun 20, 2007

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Lauri A Dayton

Title

Office Manager

Phone

(503) 292-7398

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1182297600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1639374440",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9155 SW BARNES RD STE 211",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972256629",
            "telephone_number": "503-520-1260",
            "fax_number": "503-469-9176"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9155 SW BARNES RD STE 211",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972256629",
            "telephone_number": "503-520-1260",
            "fax_number": "503-469-9176"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FREDERICK T WALLER MD PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-20",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "DAYTON",
        "authorized_official_first_name": "LAURI",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "503-292-7398",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "207T00000X",
            "taxonomy_group": "",
            "desc": "Neurological Surgery",
            "state": "OR",
            "license": "MD08927",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Fred Meyer Stores Inc (Fred Meyer Pharmacy)
• Susan Dianne Fredd-Allison, LCSW
• Heidi Lynn Fredeen
• Raelynn Leann Freden
• Desiree Fredenburg, LMT
• Brent Frederick, RPH
• Carrie E. Frederick, MD
• Eric J Frederick, AU.D
• Julie D. Frederick, PH.D.
• Kate R Frederick, RPH

• Neurological Surgery Physician in Portland, OR
• Providers in Portland, OR by specialty
• Neurological Surgery Physician in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.