Individual provider · Type 1 NPI

Michael Van Wyngarden, PHYSICIAN ASSISTANT

Medical Physician Assistant · Portland, OR

NPI number 1790379451 Active

Practice location

3303 S Bond Ave
Portland, OR 97239-4501

Call (503) 494-5058 Map

Fax (503) 494-3465

Mailing address

1400 SW 5th Ave Ste 500
Portland, OR 97201-5537

Other practice locations

  • 3181 SW Sam Jackson Park Rd # OC14HO, Portland, OR 97239-3011 · (503) 494-7999

Specialties and licenses

TaxonomyCodeLicense
Medical Physician Assistant Primary 363AM0700XPA223530 (OR)
Physician Assistant 363A00000XPA.0007421 (CO)

Medical Physician Assistant: Definition to come...

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About NPI 1790379451

Michael Van Wyngarden, PHYSICIAN ASSISTANT's National Provider Identifier is 1790379451, issued on Feb 23, 2021. The primary taxonomy on file is Medical Physician Assistant (363AM0700X), and the practice location is in Portland, OR. The record was last updated on Mar 11, 2025.