Active NPI 1588861058 Individual Practitioner Male Practitioner

Dr. Chong Wee Foo , MD

Dermatology • Eugene, OR

✓ Accepts Medicare Assignment

Professional Overview & Biography Verified Profile Summary

Dr. Chong Wee Foo, MD is a certified Dermatology practicing in Eugene, OR. With approximately 23 years of clinical experience since completing medical education in 2003, Dr. Foo delivers high-quality medical care to the local community at 1200 HILYARD ST.

Dr. Foo is affiliated with Peacehealth Medical Group and accepts Medicare assignment.

Frequently performed procedures and clinical services include destruction of precancer skin growth, 2-14 growths, established patient outpatient office visit, destruction of skin growth. Full Medicare procedure pricing transparency rates and service volume details are listed on this profile.

Practice Location & Contact Primary Location

Practice Address

1200 Hilyard St
Suite 520

Eugene, OR 974018122

Telephone 4582056160

Associated Practice Facility / Clinic

🏢 Peacehealth Medical Group Facility NPI 1447207287

Medicare Profile & Education

Medical School

Other

Graduation Year

2003

Medicare Assignment

✓ Accepts Assignment

Telehealth Flag

In-Person Only

Specialty Benchmarks & Practice Insights

Comparative analytics for Dermatology in Eugene, OR

Senior Veteran Specialist (>20 Yrs)

Practitioner Clinical Experience

23 Yrs -6.0 yrs vs City Avg

City Avg: 29.0 Yrs

State Avg: 21.5 Yrs

Regional Practice Density

12 Specialists

Practicing in Eugene, OR (217 Statewide)

Telehealth Adoption Rate

0.0% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount

54.0% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Clinical Seniority & Experience Comparison

Dr. Foo (23 Years) 23 Yrs

Eugene Specialty Average (29.0 Years) 29.0 Yrs

Performed Procedures & Service Volume

Top Medicare Part B procedures performed by this practitioner

CMS Official Data (2024)

Reporting Year:

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
17003 Destruction of precancer skin growth, 2-14 growths	1,398	267	$8.78	$6.04
99213 Established patient office or other outpatient visit, typically 15 minutes	747	552	$208.37	$87.64
17000 Destruction of skin growth	488	388	$139.18	$53.86
11102 Tangential biopsy of single skin lesion	206	188	$145.45	$92.07
17110 Destruction of up to 14 skin growths	170	147	$227.21	$107.20
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	152	152	$253.58	$106.34
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	62	49	$304.45	$123.54
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	60	56	$120.57	$54.45
99202 New patient office or other outpatient visit, typically 20 minutes	59	59	$154.12	$69.56
11103 Biopsy of related skin growth, each additional growth	46	37	$82.26	$48.41
11603 Removal of cancer skin growth of body, arms, or legs, 2.1-3.0 cm	32	29	$315.69	$133.54
13121 Repair of wound (2.6 to 7.5 centimeters) of scalp, arms, and/or legs	32	31	$869.27	$387.83
13101 Complicated repair of wound of trunk, 2.6-7.5 cm	28	26	$789.89	$367.04
12032 Intermediate repair of wound of scalp, underarms, trunk, arms, or legs, 2.6-7.5 cm	23	22	$593.37	$279.71
11602 Removal of cancer skin growth of body, arms, or legs, 1.1-2.0 cm	22	21	$263.82	$117.69
11402 Removal of noncancer skin growth of body, arms, or legs, 1.1-2.0 cm	22	22	$184.41	$82.96
13132 Complicated repair of wound of forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, or feet, 2.6-7.5 cm	21	20	$1026.95	$450.58
11104 Punch biopsy, first skin growth	18	17	$224.89	$120.39
17004 Destruction of precancer skin growth, 15 or more growths	15	12	$347.40	$161.38
17262 Destruction of cancer skin growth of trunk, arms, or legs, 1.1-2.0 cm	14	14	$291.89	$141.49
12031 Intermediate repair of wound of scalp, underarms, trunk, arms, or legs, 2.5 cm or less	13	12	$475.62	$253.39
11403 Removal of noncancer skin growth of body, arms, or legs, 2.1-3.0 cm	12	11	$234.25	$95.09

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
17003 Destruction of precancer skin growth, 2-14 growths	1,559	294	$17.00	$6.50
99213 Established patient office or other outpatient visit, typically 15 minutes	645	485	$232.00	$86.56
17000 Destruction of skin growth	514	411	$137.11	$52.99
11102 Tangential biopsy of single skin lesion	229	205	$245.67	$91.30
17110 Destruction of up to 14 skin growths	172	154	$285.92	$108.22
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	129	129	$282.00	$107.24
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	105	96	$330.00	$122.84
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	79	73	$144.00	$54.33
11103 Biopsy of related skin growth, each additional growth	67	45	$134.00	$48.59
99202 New patient office or other outpatient visit, typically 20 minutes	66	66	$184.00	$69.55
13121 Repair of wound (2.6 to 7.5 centimeters) of scalp, arms, and/or legs	57	55	$1093.32	$407.18
11602 Removal of cancer skin growth of body, arms, or legs, 1.1-2.0 cm	42	38	$314.00	$117.93
11603 Removal of cancer skin growth of body, arms, or legs, 2.1-3.0 cm	36	33	$356.00	$134.21
13101 Complicated repair of wound of trunk, 2.6-7.5 cm	29	26	$942.12	$350.79
13132 Complicated repair of wound of forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, or feet, 2.6-7.5 cm	21	19	$1217.00	$454.62
12032 Intermediate repair of wound of scalp, underarms, trunk, arms, or legs, 2.6-7.5 cm	21	21	$785.00	$293.47
17262 Destruction of cancer skin growth of trunk, arms, or legs, 1.1-2.0 cm	20	16	$384.20	$137.79
11402 Removal of noncancer skin growth of body, arms, or legs, 1.1-2.0 cm	18	18	$220.00	$82.73
17004 Destruction of precancer skin growth, 15 or more growths	18	16	$420.00	$162.94
99204 New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more	17	17	$425.00	$159.92
11104 Punch biopsy, first skin growth	15	14	$331.00	$121.74

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
17003 Destruction of precancer skin growth, 2-14 growths	1,691	306	$17.00	$6.66
99213 Established patient office or other outpatient visit, typically 15 minutes	611	470	$232.00	$87.95
17000 Destruction of skin growth	535	418	$136.28	$52.61
11102 Tangential biopsy of single skin lesion	249	218	$245.70	$92.11
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	207	189	$330.00	$124.79
17110 Destruction of up to 14 skin growths	199	165	$285.88	$109.35
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	108	108	$282.00	$108.63
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	105	98	$144.00	$54.86
11103 Biopsy of related skin growth, each additional growth	73	47	$134.00	$49.91
99202 New patient office or other outpatient visit, typically 20 minutes	60	60	$184.00	$70.82
13121 Repair of wound (2.6 to 7.5 centimeters) of scalp, arms, and/or legs	45	41	$1090.74	$414.75
11602 Removal of cancer skin growth of body, arms, or legs, 1.1-2.0 cm	30	27	$314.00	$119.68
12032 Intermediate repair of wound of scalp, underarms, trunk, arms, or legs, 2.6-7.5 cm	29	27	$771.47	$282.68
11402 Removal of noncancer skin growth of body, arms, or legs, 1.1-2.0 cm	29	24	$220.00	$84.66
11603 Removal of cancer skin growth of body, arms, or legs, 2.1-3.0 cm	28	26	$356.00	$136.07
13101 Complicated repair of wound of trunk, 2.6-7.5 cm	22	21	$913.84	$338.73
17262 Destruction of cancer skin growth of trunk, arms, or legs, 1.1-2.0 cm	22	21	$390.36	$147.15
13132 Complicated repair of wound of forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, or feet, 2.6-7.5 cm	22	20	$1217.00	$464.54
17004 Destruction of precancer skin growth, 15 or more growths	21	17	$420.00	$165.20
99204 New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more	20	20	$425.00	$156.24
11200 Removal of skin tag, 1-15 skin tags	15	15	$190.83	$69.48
11104 Punch biopsy, first skin growth	15	13	$331.00	$124.84

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
17003 Destruction of precancer skin growth, 2-14 growths	1,176	251	$17.00	$6.40
99213 Established patient office or other outpatient visit, typically 15 minutes	446	382	$232.00	$89.19
17000 Destruction of skin growth	437	360	$132.63	$50.99
11102 Tangential biopsy of single skin lesion	259	231	$254.19	$97.80
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	221	205	$330.00	$126.46
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	149	149	$282.00	$109.61
17110 Destruction of up to 14 skin growths	120	112	$282.51	$107.86
11103 Biopsy of related skin growth, each additional growth	114	66	$134.00	$51.96
99202 New patient office or other outpatient visit, typically 20 minutes	80	80	$184.00	$71.20
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	57	54	$144.00	$55.04
13121 Repair of wound (2.6 to 7.5 centimeters) of scalp, arms, and/or legs	36	33	$1041.72	$404.38
11602 Removal of cancer skin growth of body, arms, or legs, 1.1-2.0 cm	29	25	$324.83	$121.86
13101 Complicated repair of wound of trunk, 2.6-7.5 cm	29	26	$942.12	$358.72
11603 Removal of cancer skin growth of body, arms, or legs, 2.1-3.0 cm	27	23	$356.00	$138.41
12032 Intermediate repair of wound of scalp, underarms, trunk, arms, or legs, 2.6-7.5 cm	21	21	$747.62	$285.29
13132 Complicated repair of wound of forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, or feet, 2.6-7.5 cm	19	19	$1217.00	$472.58
17262 Destruction of cancer skin growth of trunk, arms, or legs, 1.1-2.0 cm	19	14	$440.11	$148.00
17004 Destruction of precancer skin growth, 15 or more growths	18	14	$420.00	$162.42
11402 Removal of noncancer skin growth of body, arms, or legs, 1.1-2.0 cm	17	16	$220.00	$85.07
11104 Punch biopsy, first skin growth	14	13	$331.00	$127.81
11604 Removal of cancer skin growth of body, arms, or legs, 3.1-4.0 cm	13	12	$427.54	$165.91
99204 New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more	12	12	$425.00	$163.99
12031 Intermediate repair of wound of scalp, underarms, trunk, arms, or legs, 2.5 cm or less	12	12	$675.00	$249.44

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
17003 Destruction of precancer skin growth, 2-14 growths	1,477	261	$15.00	$5.98
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	552	466	$284.00	$107.48
17000 Destruction of skin growth	432	352	$141.16	$52.56
11102 Tangential biopsy of single skin lesion	268	228	$246.76	$92.70
99213 Established patient office or other outpatient visit, typically 15 minutes	174	140	$194.00	$73.69
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	133	133	$283.00	$105.85
17110 Destruction of up to 14 skin growths	114	106	$288.84	$108.62
11103 Biopsy of related skin growth, each additional growth	99	63	$142.00	$52.48
99202 New patient office or other outpatient visit, typically 20 minutes	70	70	$200.00	$74.90
13121 Repair of wound (2.6 to 7.5 centimeters) of scalp, arms, and/or legs	41	35	$1115.12	$416.67
11602 Removal of cancer skin growth of body, arms, or legs, 1.1-2.0 cm	37	29	$329.00	$122.53
17004 Destruction of precancer skin growth, 15 or more growths	25	20	$403.00	$147.36
13132 Complicated repair of wound of forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, or feet, 2.6-7.5 cm	23	20	$1271.00	$473.60
17262 Destruction of cancer skin growth of trunk, arms, or legs, 1.1-2.0 cm	23	22	$396.78	$145.02
12032 Intermediate repair of wound of scalp, underarms, trunk, arms, or legs, 2.6-7.5 cm	22	22	$734.55	$280.09
11402 Removal of noncancer skin growth of body, arms, or legs, 1.1-2.0 cm	18	18	$223.00	$84.48
11603 Removal of cancer skin growth of body, arms, or legs, 2.1-3.0 cm	17	16	$375.50	$139.42
13101 Complicated repair of wound of trunk, 2.6-7.5 cm	15	14	$1063.00	$397.62
99442 Telephone medical discussion with physician, 11-20 minutes	14	14	$78.79	$65.76
11104 Punch biopsy, first skin growth	14	13	$331.00	$122.08
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	12	11	$155.00	$44.66

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
17003 Destruction of precancer skin growth, 2-14 growths	1,938	322	$14.05	$5.53
17000 Destruction of skin growth	535	427	$132.52	$50.70
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	472	424	$275.19	$107.32
11102 Tangential biopsy of single skin lesion	337	294	$237.67	$91.11
99213 Established patient office or other outpatient visit, typically 15 minutes	287	219	$186.37	$72.79
17110 Destruction of up to 14 skin growths	166	140	$281.89	$107.56
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	143	143	$275.20	$106.95
99202 New patient office or other outpatient visit, typically 20 minutes	121	121	$191.40	$75.09
11103 Biopsy of related skin growth, each additional growth	112	73	$135.32	$52.67
17004 Destruction of precancer skin growth, 15 or more growths	66	51	$377.21	$148.74
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	62	61	$151.61	$44.50
13121 Repair of wound (2.6 to 7.5 centimeters) of scalp, arms, and/or legs	46	42	$1090.85	$422.93
11602 Removal of cancer skin growth of body, arms, or legs, 1.1-2.0 cm	36	30	$329.18	$126.50
13132 Complicated repair of wound of forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, or feet, 2.6-7.5 cm	33	31	$1224.12	$476.45
11104 Punch biopsy, first skin growth	29	29	$318.07	$122.82
17262 Destruction of cancer skin growth of trunk, arms, or legs, 1.1-2.0 cm	28	19	$369.11	$131.12
11200 Removal of skin tag, 1-15 skin tags	23	22	$162.39	$60.09
11642 Removal of cancer skin growth of face, ears, eyelids, nose, lips, or mouth, 1.1-2.0 cm	21	20	$346.36	$134.73
99201 New patient office or other outpatient visit, typically 10 minutes	20	20	$145.00	$45.15
11603 Removal of cancer skin growth of body, arms, or legs, 2.1-3.0 cm	20	19	$367.45	$140.69
11402 Removal of noncancer skin growth of body, arms, or legs, 1.1-2.0 cm	19	17	$212.89	$80.49
13101 Complicated repair of wound of trunk, 2.6-7.5 cm	19	18	$946.71	$365.81
12032 Intermediate repair of wound of scalp, underarms, trunk, arms, or legs, 2.6-7.5 cm	18	18	$730.33	$279.40
11622 Removal of cancer skin growth of scalp, neck, hands, feet, or genitals, 1.1-2.0 cm	16	15	$330.59	$127.25
12031 Intermediate repair of wound of scalp, underarms, trunk, arms, or legs, 2.5 cm or less	14	14	$599.93	$234.60

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
17003 Destruction of precancer skin growth, 2-14 growths	1,494	285	$13.00	$5.10
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	572	461	$264.00	$104.98
17000 Destruction of skin growth	493	398	$146.96	$52.36
11100 Biopsy of single growth of skin and/or tissue	331	290	$250.42	$98.34
99213 Established patient office or other outpatient visit, typically 15 minutes	302	231	$179.00	$70.89
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	188	188	$265.47	$105.36
17110 Destruction of up to 14 skin growths	137	121	$274.75	$108.46
99202 New patient office or other outpatient visit, typically 20 minutes	136	136	$184.00	$73.38
11101 Biopsy of each additional growth of skin and/or tissue	105	74	$81.00	$31.62
17004 Destruction of precancer skin growth, 15 or more growths	49	39	$361.24	$138.02
13121 Repair of wound (2.6 to 7.5 centimeters) of scalp, arms, and/or legs	46	41	$1033.30	$399.33
11602 Removal of cancer skin growth of body, arms, or legs, 1.1-2.0 cm	37	28	$447.81	$119.82
13132 Complicated repair of wound of forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, or feet, 2.6-7.5 cm	32	31	$1178.31	$458.31
17262 Destruction of cancer skin growth of trunk, arms, or legs, 1.1-2.0 cm	31	29	$399.15	$145.09
11402 Removal of noncancer skin growth of body, arms, or legs, 1.1-2.0 cm	23	20	$348.04	$81.60
11603 Removal of cancer skin growth of body, arms, or legs, 2.1-3.0 cm	20	17	$526.55	$139.12
11642 Removal of cancer skin growth of face, ears, eyelids, nose, lips, or mouth, 1.1-2.0 cm	19	19	$442.45	$132.79
13101 Complicated repair of wound of trunk, 2.6-7.5 cm	18	18	$951.92	$328.91
11200 Removal of skin tag, 1-15 skin tags	17	17	$181.41	$64.55
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	14	14	$145.00	$42.90
11622 Removal of cancer skin growth of scalp, neck, hands, feet, or genitals, 1.1-2.0 cm	14	13	$544.57	$125.61
17282 Destruction of cancer skin growth of face, ears, eyelids, nose, lips, or mouth, 1.1-2.0 cm	13	12	$486.42	$176.80
99201 New patient office or other outpatient visit, typically 10 minutes	12	12	$145.00	$43.57

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
17003 Destruction of precancer skin growth, 2-14 growths	1,740	314	$13.47	$5.40
17000 Destruction of skin growth	565	435	$160.77	$48.30
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	547	438	$263.06	$103.14
11100 Biopsy of single growth of skin and/or tissue	401	337	$252.56	$94.01
99213 Established patient office or other outpatient visit, typically 15 minutes	290	212	$178.07	$70.94
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	195	195	$265.49	$104.25
11101 Biopsy of each additional growth of skin and/or tissue	170	106	$80.41	$31.76
17110 Destruction of up to 14 skin growths	161	145	$270.44	$104.07
99202 New patient office or other outpatient visit, typically 20 minutes	87	87	$173.74	$72.06
13121 Repair of wound (2.6 to 7.5 centimeters) of scalp, arms, and/or legs	55	49	$1021.50	$391.77
17262 Destruction of cancer skin growth of trunk, arms, or legs, 1.1-2.0 cm	49	36	$382.01	$133.22
13132 Complicated repair of wound of forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, or feet, 2.6-7.5 cm	45	43	$1158.62	$462.35
11602 Removal of cancer skin growth of body, arms, or legs, 1.1-2.0 cm	43	36	$397.35	$120.37
17004 Destruction of precancer skin growth, 15 or more growths	43	38	$369.65	$139.86
11603 Removal of cancer skin growth of body, arms, or legs, 2.1-3.0 cm	37	29	$432.84	$141.27
13101 Complicated repair of wound of trunk, 2.6-7.5 cm	23	21	$930.61	$342.12
11402 Removal of noncancer skin growth of body, arms, or legs, 1.1-2.0 cm	22	16	$278.86	$79.02
11200 Removal of skin tag, 1-15 skin tags	21	21	$212.00	$65.51
11642 Removal of cancer skin growth of face, ears, eyelids, nose, lips, or mouth, 1.1-2.0 cm	18	14	$409.33	$131.75
12032 Intermediate repair of wound of scalp, underarms, trunk, arms, or legs, 2.6-7.5 cm	18	17	$746.00	$285.87
11623 Removal of cancer skin growth of scalp, neck, hands, feet, or genitals, 2.1-3.0 cm	14	14	$423.36	$145.89
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	12	12	$145.00	$42.25
17282 Destruction of cancer skin growth of face, ears, eyelids, nose, lips, or mouth, 1.1-2.0 cm	12	12	$459.58	$173.63

Medical Specialties & State Licenses

Dermatology Primary Specialty

NUCC Taxonomy Code: 207N00000X

State License OR MD161384

A dermatologist is trained to diagnose and treat pediatric and adult patients with benign and malignant disorders of the skin, mouth, external genitalia, hair and nails, as well as a number of sexually transmitted diseases. The dermatologist has had additional training and experience in the diagnosis and treatment of skin cancers, melanomas, moles and other tumors of the skin, the management of contact dermatitis and other allergic and nonallergic skin disorders, and in the recognition of the skin manifestations of systemic (including internal malignancy) and infectious diseases. Dermatologists have special training in dermatopathology and in the surgical techniques used in dermatology. They also have expertise in the management of cosmetic disorders of the skin such as hair loss and scars and the skin changes associated with aging.

Additional State Medicaid & Healthcare Payer Identifiers

Medicaid State Provider ID

500660526 (OR)

Commercial Insurance / Payer ID Rr Medicare

P01255384 (OR)

Hospital & Practice Group Affiliations

Peacehealth Medical Group

4010 Aerial Way, Eugene, OR 974029757

Phone: 6132724978

Practice Associates & Co-Workers

Healthcare professionals and specialists practicing at this location or sharing practice phone/fax

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Pediatric Nurse Practitioner

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Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

6 Historical Events

✅

NPI Profile Active May 09, 2016

NPI status registered as active in NPPES database

📍

Updated Practice Location May 09, 2016

Registered at 1200 HILYARD ST, SUITE 520, EUGENE, OR 974018122 (Tel: 4582056160)

📍

Updated Business Mailing Address May 09, 2016

Registered at 1115 SE 164TH AVE, DEPT 358, VANCOUVER, WA 986839324

👤

Provider Name / Credentials Updated May 09, 2016

Recorded as CHONG WEE FOO, M.D.

🎓

Medical Taxonomy / Specialty Registered (Primary Specialty) May 09, 2016

Dermatology (License #MD161384 in OR)

🟢

Initial NPI Registration & Enumeration June 28, 2007

First registered as active Individual Practitioner in NPPES Database.

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NPI Administrative Meta

NPI Number: 1588861058

Entity Type:

Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)

Enumeration Date: June 28, 2007

Last Update: May 09, 2016

Sole Proprietor: No

Update or Correct Profile

Mailing Address

1115 Se 164th Ave, Dept 358

Vancouver, WA 986839324

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