DMITRIY SHORE PA-C NPI 1124177902

NPI Information

NPI: 1124177902
Provider Name: DMITRIY SHORE, PA-C
Classification: Physician Assistant - 363AM0700X
Entity Type: Individual

Specialization: Medical

Organization: ADVANCED PAIN MANAGEMENT CENTER

PECOS Registration: Yes

Address:
10305 SW PARK WAY STE 300
PORTLAND, OR
ZIP 97225
Phone: (503) 295-0730
Get Directions

Dmitriy Shore, PA-C is a medical physician assistant in Portland, OR with 24 years of experience. Dmitriy Shore, PA-C NPI is 1124177902. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

10305 SW PARK WAY STE 300
PORTLAND, OR
ZIP 97225-033
Phone: (503) 295-0730
Fax: (503) 295-0731

The NPI 1124177902 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 1/9/2007 and was last updated on 7/8/2007.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	363AM0700X	Physician Assistant	Medical	PA00724	OREGON	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	Q37415	MEDICARE UPIN	OREGON
2	130729	MEDICARE ID-TYPE UNSPECIFIED	OREGON

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

NPI Synchronization or Removal

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