Gresham Podiatry Center, LLC

Primary specialty

Foot & Ankle Surgery PodiatristTaxonomy code 213ES0103X

License

307 Issued in OR

Legal business name

GRESHAM PODIATRY CENTER, LLC

Practice address

831 NW Council Dr
Suite #203
Gresham, OR 97030-3721

Phone

(503) 667-6600

Fax

(503) 667-6608

NPI assigned

May 28, 2006

Organization subpart

No

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

Authorized official

Name

Dr. Derek John McCammon, D.P.M.

Title

Owner

Phone

(503) 667-6600

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1148774400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1207094400000",
    "number": "1891742318",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "831 NW COUNCIL DR",
            "address_2": "SUITE #203",
            "city": "GRESHAM",
            "state": "OR",
            "postal_code": "970303721",
            "telephone_number": "503-667-6600",
            "fax_number": "503-667-6608"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "831 NW COUNCIL DR",
            "address_2": "SUITE #203",
            "city": "GRESHAM",
            "state": "OR",
            "postal_code": "970303721",
            "telephone_number": "503-667-6600",
            "fax_number": "503-667-6608"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRESHAM PODIATRY CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-28",
        "last_updated": "2008-04-02",
        "status": "A",
        "authorized_official_last_name": "MCCAMMON",
        "authorized_official_first_name": "DEREK",
        "authorized_official_middle_name": "JOHN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "503-667-6600",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.P.M."
    },
    "taxonomies": [
        {
            "code": "213ES0103X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "OR",
            "license": "307",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP NPI",
            "identifier": "1891742318",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Foot & Ankle Surgery Podiatrist in Gresham, OR
• Providers in Gresham, OR by specialty
• Foot & Ankle Surgery Podiatrist in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 2, 2008; 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.