Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Mountain West Derm-Blackhart, PLLC

Organization Dermatology Physician · NPI 1316656994

Mountain West Derm-Blackhart, PLLC is a Dermatology Physician in Tigard, Oregon. Registered with an NPI since 2022.

In the registry since
2022
What do these letters mean?
PLLC — Professional limited liability company
A form of business registration, not a clinical qualification.

See every abbreviation used in this directory →

Practice location Address checks out

10215 SW Hall Blvd
Tigard, OR 97223-8809
Phone: (503) 245-2415
Fax: (503) 244-5963
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Dermatology Physician (primary) Taxonomy 207N00000X

Record details

NPI number1316656994
Entity typeOrganization (Type 2)
Organization subpartYes
Parent organizationMountain West Derm-Blackhart, PLLC
Authorized official Jeffrey Shackelton — Owner · (775) 283-4086
NPI enumeratedNovember 22, 2022
Last updated in NPPESNovember 22, 2022
Certification dateNovember 22, 2022
Mailing address10215 Sw Hall Blvd, Tigard, OR 97223-8809

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