| NPI | 1124783345 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TYLER MANSON Podiatric Physician 503-635-7742 |
| Organization Subpart ? | No |
| Primary Taxonomy | 213E00000X Podiatrist |
| Additional Taxonomies | 213EP1101X Podiatrist, Primary Podiatric Medicine |
| 213ER0200X Podiatrist, Radiology | |
| 213ES0000X Podiatrist, Sports Medicine | |
| 213ES0131X | |
| Enumeration Date | 2021-11-02 |
| Last Update Date | 2022-03-24 |