| NPI | 1639175813 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TIMOTHY SHANNAHAN CLEARY Sole Member 503-520-0777 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OR 13852) |
| Enumeration Date | 2005-06-22 |
| Last Update Date | 2007-10-16 |