| NPI | 1164780060 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KATHY DEATON Practice Administrator 503-623-8376 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QP2300X Clinic/Center Primary Care (Licence: OR DO10396) |
| Additional Taxonomies | 261QP2300X Clinic/Center Primary Care (Licence: OR DO15134) |
| 261QP2300X Clinic/Center Primary Care (Licence: OR PA153023) | |
| 261QP2300X Clinic/Center Primary Care (Licence: OR PA00266) | |
| Enumeration Date | 2012-04-27 |
| Last Update Date | 2018-04-17 |