Fardowsa Shariff Idris, PHYSICIAN ASSISTANT

NPI #1609419225 in Tualatin, Oregon

Provider Information

NPI Number: 1609419225
Entity Type: Individual
Name: Fardowsa Shariff Idris, PHYSICIAN ASSISTANT
Gender: Not Specified
Sole Proprietor: Yes
Primary Specialty: Physician Assistant
Credential: PHYSICIAN ASSISTANT
Enumeration Date: Oct 27, 2019
Last Updated: Dec 11, 2020

Practice Location

Address: 19255 SW 65TH AVE STE 200
City: Tualatin
State: Oregon
ZIP Code: 97062-9712
Phone: (503) 828-1150

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Physician Assistant	363A00000X	Primary

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