| NPI | 1043874696 |
|---|---|
| Former Legal Business Name | MODERN NOSE CLINIC LLC |
| Entity Type | Organization |
| Authorized Contact | DOUGLAS SKARADA Medical Director 503-584-1174 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 207Y00000X Otolaryngology |
| Enumeration Date | 2019-04-30 |
| Last Update Date | 2019-04-30 |