Provider Demographics
NPI:1053423400
Name:PFEFER, CHAD T (MD)
Entity type:Individual
Prefix:
First Name:CHAD
Middle Name:T
Last Name:PFEFER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1920 NW AMBERGLEN PKWY
Mailing Address - Street 2:STE 150
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97006-6977
Mailing Address - Country:US
Mailing Address - Phone:971-327-4356
Mailing Address - Fax:971-327-4355
Practice Address - Street 1:1920 NW AMBERGLEN PKWY
Practice Address - Street 2:STE 150
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97006-6977
Practice Address - Country:US
Practice Address - Phone:971-327-4356
Practice Address - Fax:971-327-4355
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2015-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD21275207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR288502Medicaid
ORP01500452Medicare PIN
ORR168704Medicare PIN
OR288502Medicaid
OR117296Medicare PIN