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1669487161
LYLE JAMES FAGNAN
PORTLAND, OR
NPI
1669487161
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
207Q00000X Family Medicine
(Licence: OR MD10673)
Enumeration Date
2006-07-31
Last Update Date
2007-07-13
Business Address
LYLE JAMES FAGNAN MD
4411 SW VERMONT ST
PORTLAND, OR 97219-1020
Phone number: 503-494-9992
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Mailing Address
LYLE JAMES FAGNAN MD
3181 SW SAM JACKSON PARK RD L222
PORTLAND, OR 97239-3011
Phone number: 503-494-1582
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