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1770561813
JOHN M CUSTIS
GRESHAM, OR
NPI
1770561813
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
207R00000X Internal Medicine
(Licence: OR MD09069)
Enumeration Date
2006-01-09
Last Update Date
2007-12-21
Business Address
-- JOHN M CUSTIS MD
24900 SE STARK STE 109
GRESHAM, OR 97030
Phone number: 503-667-1015
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Mailing Address
-- JOHN M CUSTIS MD
PO BOX 23200
PORTLAND, OR 97281-3200
Phone number: 503-667-1015
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