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1710655584
SAMUEL MOODY
PORTLAND, OR
NPI
1710655584
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
363AM0700X Physician Assistant, Medical
(Licence: OR PA217671)
Enumeration Date
2021-09-05
Last Update Date
2024-01-09
Business Address
SAMUEL MOODY PA-C
3181 SW SAM JACKSON PARK RD
PORTLAND, OR 97239-3011
Phone number: 503-494-6596
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Mailing Address
SAMUEL MOODY PA-C
1400 SW 5TH AVE STE 500
PORTLAND, OR 97201-5537
Phone number: 866-617-6855
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