Daniel C Root, MD | |
9280 Se Sunnyside Blvd, Ste 200, Clackamas, OR 97015 | |
(503) 962-1840 | |
Not Available |
Full Name | Daniel C Root |
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Gender | Male |
Speciality | Dermatology |
Location | 9280 Se Sunnyside Blvd, Clackamas, Oregon |
Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1184824237 | NPI | - | NPPES |
8369662 | Medicaid | WA |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207N00000X | Dermatology | MD00042937 (Washington) | Secondary |
207N00000X | Dermatology | MD223071 (Oregon) | Primary |
Entity Name | Providence Health & Services Oregon |
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Entity Type | Part B Supplier - Clinic/group Practice |
Entity Identifiers | NPI Number: 1023488343 PECOS PAC ID: 0648183608 Enrollment ID: O20031106000652 |
Mailing Address | Practice Location Address |
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Daniel C Root, MD Po Box 3158, Portland, OR 97208-3158 Ph: (503) 215-6494 | Daniel C Root, MD 9280 Se Sunnyside Blvd, Ste 200, Clackamas, OR 97015 Ph: (503) 962-1840 |
Jo M Martin, MD Dermatology Medicare: Accepting Medicare Assignments Practice Location: 9900 Se Sunnyside Rd, Nw Permanente Pc, Physicians And Surgeons, Clackamas, OR 97015 Phone: 503-571-3332 | |
Peter E Goodkin, MD Dermatology Medicare: Not Enrolled in Medicare Practice Location: 9775 Se Sunnyside Road, Suite 500, Clackamas, OR 97015 Phone: 503-654-7546 Fax: 503-786-3542 | |
Matthew G Basco, MD Dermatology Medicare: Accepting Medicare Assignments Practice Location: 9800 Se Sunnyside Rd, Mt Scott Medical Office, Clackamas, OR 97015 Phone: 503-571-8490 | |
Dr. Zachary G Pena, M.D. Dermatology Medicare: Accepting Medicare Assignments Practice Location: 10151 Se Sunnyside Rd Ste 240, Clackamas, OR 97015 Phone: 503-962-1840 | |
Travis James Widman, M.D. Dermatology Medicare: Accepting Medicare Assignments Practice Location: 9900 Se Sunnyside Rd, Clackamas, OR 97015 Phone: 503-571-3332 | |
Mary Clare Bohnett, MD Dermatology Medicare: Medicare Enrolled Practice Location: 10151 Se Sunnyside Rd Ste 240, Clackamas, OR 97015 Phone: 503-962-1840 |