| NPI | 1205188893 |
|---|---|
| Doing Business As | PROVIDENCE MEDICAL GROUP INFECTIOUS DISEASE CONSULTANTS EAST |
| Entity Type | Organization |
| Authorized Contact | KEENAN B FREEMAN CFO 503-893-6524 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center |
| Additional Taxonomies | 207R00000X Internal Medicine |
| 207RI0200X Internal Medicine Infectious Disease | |
| Enumeration Date | 2012-10-08 |
| Last Update Date | 2013-09-23 |