| NPI | 1881878650 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEREMY M LAKE Md 503-640-1614 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology (Licence: OR MD24736) |
| Enumeration Date | 2007-12-28 |
| Last Update Date | 2007-12-28 |