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5330 Ne Glisan St Suite 100 Portland OR 97213-3069 | |
(503) 215-9706 | |
Not Available |
Full Name | |
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Speciality | Internal Medicine |
Location | 5330 Ne Glisan St, Portland, Oregon |
Authorized Official Name and Position | Donald W Anderson (ASST SECRETARY ENROLLMENT) |
Authorized Official Contact | 4255255392 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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Po Box 3158 Portland OR 97208-3158 Ph: () - | 5330 Ne Glisan St Suite 100 Portland OR 97213-3069 Ph: (503) 215-9706 |
NPI Number | 1841466141 |
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Provider Enumeration Date | 05/06/2008 |
Last Update Date | 06/13/2024 |
Identifier | Type | State | Issuer |
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1841466141 | NPI | - | NPPES |
500400318 | Medicaid | OR |
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