| Physician On Duty | |
|
14805 Sw Blanton St. Beaverton OR 97007 | |
| (503) 957-9632 | |
| Not Available |
| Full Name | Physician On Duty |
|---|---|
| Speciality | General Practice |
| Location | 14805 Sw Blanton St., Beaverton, Oregon |
| Authorized Official Name and Position | Sandra L Jolly (BILLING MANAGER) |
| Authorized Official Contact | 5037264685 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Physician On Duty 14805 Sw Blanton St. Beaverton OR 97007 Ph: (503) 957-9632 | Physician On Duty 14805 Sw Blanton St. Beaverton OR 97007 Ph: (503) 957-9632 |
| NPI Number | 1275787780 |
|---|---|
| Provider Enumeration Date | 11/11/2008 |
| Last Update Date | 11/11/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1275787780 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | (* (Not Available)) | Primary |
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