Pediatric Endocrinology of Portland, P.C.

Primary specialty

Pediatric Endocrinology PhysicianTaxonomy code 2080P0205X

License

MD22738 Issued in OR

Legal business name

PEDIATRIC ENDOCRINOLOGY OF PORTLAND, P.C.

Practice address

9155 SW Barnes Rd
Suite 931
Portland, OR 97225-6625

Phone

(503) 206-3636

Fax

(503) 206-3635

NPI assigned

May 10, 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

Dr. Dale Michael Willis, MD, PHDNPI 1013978378

Title

President

Phone

(503) 206-3636

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Dale Michael Willis, M.D.

  • Pediatric Endocrinology Physician
  • Portland, OR
  • NPI 1013978378
  Authorized official Same address or phone

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

{
    "created_epoch": "1178755200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1639383466",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9155 SW BARNES RD",
            "address_2": "SUITE 931",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972256625",
            "telephone_number": "503-206-3636",
            "fax_number": "503-206-3635"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9155 SW BARNES RD",
            "address_2": "SUITE 931",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972256625",
            "telephone_number": "503-206-3636",
            "fax_number": "503-206-3635"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDIATRIC ENDOCRINOLOGY OF PORTLAND, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-10",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "WILLIS",
        "authorized_official_first_name": "DALE",
        "authorized_official_middle_name": "MICHAEL",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "503-206-3636",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD, PHD"
    },
    "taxonomies": [
        {
            "code": "2080P0205X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Endocrinology",
            "state": "OR",
            "license": "MD22738",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "287841",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Pediatric Associates of the Northwest, PC
• Pediatric Cardiology Center of Oregon PC (Childrens Cardiac Center of Oregon)
• Pediatric Dental Group
• Pediatric Dentistry of Portland LLC
• Pediatric Dentistry, RC
• Pediatric Intensive Care Trauma Associates PC
• Pediatric Occupational Therapy Solutions, LLC
• Pediatric Orthotic and Prosthetic Services - Northwest, LLC
• Pediatric Sensory Therapy, LLC
• Pediatric Urgent Care LLC

• Pediatric Endocrinology Physician in Portland, OR
• Providers in Portland, OR by specialty
• Pediatric Endocrinology 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.