Fernstrom, Bruce

Fernstrom, Bruce is an individual health care provider with primary practice located at 10000 Se Main St Suite 342, Portland OR 97216-2448. He recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Surgical, which is considered as his primary health care specialty. Fernstrom, Bruce can be contacted via phone (503) 255-5524.

Contact Information

Primary practice address
10000 Se Main St Suite 342 Portland OR 97216-2448
Phone: (503) 255-5524
Fax: (503) 255-5120
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Surgical 363AS0400X PA00805 Oregon

Profile Details

NPI number 1255329967
LBN Legal business name Fernstrom, Bruce
Credentials Physician Assistant (PA)
Entity Individual
Sole proprietor 1 No
Enumeration date Oct 7th, 2005
Last updated Dec 5th, 2023 - about 3 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1255329967 NPPES
Oregon MEDICAID 500600862

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