WILLAMETTE DERMATOLOGY P.C. NPI 1245221084

NPI Information

  • NPI: 1245221084
  • Provider Name: WILLAMETTE DERMATOLOGY, P.C.
  • Classification: Specialist - 174400000X
  • Entity Type: Organization
  • CLIA Number: 38D0965600
  • Address: 19875 SW 65TH AVE
    SUITE 260
    TUALATIN, OR
    ZIP 97062
  • Phone: (503) 691-1743

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NPI Details

WILLAMETTE DERMATOLOGY, P.C. is a specialist in Tualatin, OR. The provider is an individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. WILLAMETTE DERMATOLOGY, P.C. NPI is 1245221084. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

19875 SW 65TH AVE
SUITE 260
TUALATIN, OR
ZIP 97062-353
Phone: (503) 691-1743
Fax: (503) 691-0983

The provider's authorized official is Paul A Klas .
The authorized official title is Owner/physician and has the following contact phone number (503) 691-1743.

The CLIA number assigned to this NPI record is 38D0965600 - physician office with a certificate type of Certificate of Compliance.

The enumeration date for this NPI number is 11/1/2005 and was last updated on 12/8/2008.

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
1174400000XSpecialistMD21432OREGONYes

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
1R104407MEDICARE PINOREGON
21508999152OTHEROREGONINDIVIDUAL PROVIDER NPI
3151278MEDICAIDOREGON
4C74739MEDICARE UPINOREGON
5DG7086OTHEROREGONRAILROAD MEDICARE

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: 11/21/2025

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