| NPI | 1083991400 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LARRY DEAN JENSEN President 503-639-8107 |
| Organization Subpart ? | No |
| Primary Taxonomy | 213ES0131X Podiatrist Foot Surgery (Licence: OR DP00199) |
| Enumeration Date | 2011-11-14 |
| Last Update Date | 2012-05-04 |