| Hawthorne Family Medicine | |
|
2306 Se 39th Ave Portland OR 97214-5918 | |
| (503) 963-9181 | |
| (503) 963-9182 |
| Full Name | Hawthorne Family Medicine |
|---|---|
| Speciality | Family Medicine |
| Location | 2306 Se 39th Ave, Portland, Oregon |
| Authorized Official Name and Position | Bryan Dean Walls (PHYSICIAN) |
| Authorized Official Contact | 5039639181 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Hawthorne Family Medicine 2306 Se 39th Ave Portland OR 97214-5918 Ph: (503) 963-9181 | Hawthorne Family Medicine 2306 Se 39th Ave Portland OR 97214-5918 Ph: (503) 963-9181 |
| NPI Number | 1467601096 |
|---|---|
| Provider Enumeration Date | 09/18/2008 |
| Last Update Date | 09/18/2008 |
| Medicare PECOS PAC ID | 9537222526 |
|---|---|
| Medicare Enrollment ID | O20090119000045 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1467601096 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | DO20625 (Oregon) | Primary |
| Provider Name | Bryan D Walls |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1710982129 PECOS PAC ID: 7719040708 Enrollment ID: I20090119000042 |
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