| NPI | 1255367884 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TAMI L PRIDEAUX Clinic Manager 503-256-4096 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207RE0101X Internal Medicine, Endocrinology, Diabetes & Metabolism (Licence: OR MD019378) |
| Enumeration Date | 2006-06-24 |
| Last Update Date | 2020-08-22 |