Individual provider · Type 1 NPI

Dmitriy Shore, PA-C

Medical Physician Assistant · Portland, OR

NPI number 1124177902 Active

Practice location

10305 SW Park Way Ste 300
Portland, OR 97225-5033

Call (503) 295-0730 Map

Fax (503) 295-0731

Specialties and licenses

TaxonomyCodeLicense
Medical Physician Assistant Primary 363AM0700XPA00724 (OR)

Medical Physician Assistant: Definition to come...

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About NPI 1124177902

Dmitriy Shore, PA-C's National Provider Identifier is 1124177902, issued on Jan 9, 2007. The primary taxonomy on file is Medical Physician Assistant (363AM0700X), and the practice location is in Portland, OR. The record was last updated on Jul 8, 2007.