| Dtna - Portland | |
|
4709 N Lagoon Ave Portland OR 97217-7741 | |
| (503) 745-7138 | |
| (503) 745-6243 |
| Full Name | Dtna - Portland |
|---|---|
| Speciality | Clinic/center - Multi-specialty |
| Location | 4709 N Lagoon Ave, Portland, Oregon |
| Authorized Official Name and Position | Jonathan Leizman (PRESIDENT) |
| Authorized Official Contact | 2164799063 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Dtna - Portland 5500 Maryland Way Brentwood TN 37027-7048 Ph: () - | Dtna - Portland 4709 N Lagoon Ave Portland OR 97217-7741 Ph: (503) 745-7138 |
| NPI Number | 1164197083 |
|---|---|
| Provider Enumeration Date | 08/12/2021 |
| Last Update Date | 10/13/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1164197083 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Primary |
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