| Poplar Hill Family Practice | |
|
22490 Sw Mountain Rd West Linn OR 97068-9619 | |
| (503) 638-8218 | |
| (503) 638-9698 |
| Full Name | Poplar Hill Family Practice |
|---|---|
| Speciality | Family Medicine |
| Location | 22490 Sw Mountain Rd, West Linn, Oregon |
| Authorized Official Name and Position | Robert Bastian Wagner (PRESIDENT) |
| Authorized Official Contact | 5036388218 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Poplar Hill Family Practice 22490 Sw Mountain Rd West Linn OR 97068-9619 Ph: (503) 638-8218 | Poplar Hill Family Practice 22490 Sw Mountain Rd West Linn OR 97068-9619 Ph: (503) 638-8218 |
| NPI Number | 1831253673 |
|---|---|
| Provider Enumeration Date | 12/19/2006 |
| Last Update Date | 10/09/2007 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1831253673 | NPI | - | NPPES |
| 214510 | Medicaid | OR |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | MD08471 (Oregon) | Primary |
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