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707 Sw Gaines St Mailcode: Cdrc -- Attn: Jeff Reha Portland OR 97239-2901 | |
(503) 494-2709 | |
(503) 494-6868 |
Full Name | |
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Speciality | Clinic/center |
Location | 707 Sw Gaines St, Portland, Oregon |
Authorized Official Name and Position | Joseph E. Robertson (UNIVERSITY PRESIDENT) |
Authorized Official Contact | 5034948252 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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Po Box 574 Portland OR 97207-0574 Ph: (503) 494-2709 | 707 Sw Gaines St Mailcode: Cdrc -- Attn: Jeff Reha Portland OR 97239-2901 Ph: (503) 494-2709 |
NPI Number | 1073879268 |
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Provider Enumeration Date | 04/02/2012 |
Last Update Date | 02/06/2013 |
Identifier | Type | State | Issuer |
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1073879268 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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208D00000X | General Practice | (* (Not Available)) | Secondary |
261Q00000X | Clinic/center | (* (Not Available)) | Primary |
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