Basic Information
| Provider Information | |||||||||
| NPI: | 1861452765 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ACTON | ||||||||
| FirstName: | JOSEPH | ||||||||
| MiddleName: | HARCOURT | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 3777 | ||||||||
| Address2: | |||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972083777 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5034133900 | ||||||||
| FaxNumber: | 5034133710 | ||||||||
| Practice Location | |||||||||
| Address1: | 24800 SE STARK ST | ||||||||
| Address2: | |||||||||
| City: | GRESHAM | ||||||||
| State: | OR | ||||||||
| PostalCode: | 970303378 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5034138407 | ||||||||
| FaxNumber: | 5034136951 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/24/2006 | ||||||||
| LastUpdateDate: | 12/22/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/22/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 31445 | AZ | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 31447 | AZ | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | MD2010-0738 | NM | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | MD153836 | OR | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 82677901 | 05 | AZ | MEDICAID | AZ0743000 | 01 | AZ | BC/BS OF AZ | OTHER | P00089884 | 01 | AZ | RR MEDICARE | OTHER | 71878 | 01 | IA | BCBS | OTHER |