| Tanasbourne Family Medicine Llc | |
|
17200 Nw Corridor Ct Ste 105 Beaverton OR 97006-3295 | |
| (503) 614-8400 | |
| (503) 614-8411 |
| Full Name | Tanasbourne Family Medicine Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 17200 Nw Corridor Ct, Beaverton, Oregon |
| Authorized Official Name and Position | Craig Gilpin Myers (OWNER) |
| Authorized Official Contact | 5036148400 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Tanasbourne Family Medicine Llc 17200 Nw Corridor Ct Ste 105 Beaverton OR 97006-3295 Ph: (503) 614-8400 | Tanasbourne Family Medicine Llc 17200 Nw Corridor Ct Ste 105 Beaverton OR 97006-3295 Ph: (503) 614-8400 |
| NPI Number | 1144383993 |
|---|---|
| Provider Enumeration Date | 12/19/2006 |
| Last Update Date | 02/08/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1144383993 | NPI | - | NPPES |
| 154344 | Medicaid | OR |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | MD15139 (Oregon) | Primary |
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