Provider Demographics
NPI:1265427199
Name:PRESCOTT, SIDNEY J (MD)
Entity type:Individual
Prefix:DR
First Name:SIDNEY
Middle Name:J
Last Name:PRESCOTT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:7650 SW BEVELAND RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97223-8692
Mailing Address - Country:US
Mailing Address - Phone:503-249-5454
Mailing Address - Fax:503-249-5498
Practice Address - Street 1:700 NE MULTNOMAH ST
Practice Address - Street 2:SUITE 1600
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97232-2131
Practice Address - Country:US
Practice Address - Phone:503-249-5454
Practice Address - Fax:503-249-5498
Is Sole Proprietor?:No
Enumeration Date:2005-09-16
Last Update Date:2017-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD13260207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR184666OtherMEDICARE PTAN
OR277491Medicaid
ORR184666OtherMEDICARE PTAN