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1710258066
CODY LEE BALLARD
PORTLAND, OR
NPI
1710258066
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
363AM0700X Physician Assistant, Medical
(Licence: OR PA164961)
Enumeration Date
2012-01-18
Last Update Date
2020-12-17
Business Address
Mr. CODY LEE BALLARD PA-C
3181 SW SAM JACKSON PARK RD GH219
PORTLAND, OR 97239-3011
Phone number: 503-438-8822
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Mailing Address
Mr. CODY LEE BALLARD PA-C
3181 SW SAM JACKSON PARK RD # UHN-62
PORTLAND, OR 97239-3011
Phone number: 503-494-1775
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