| NPI | 1891992624 |
|---|---|
| Doing Business As | PROVIDENCE MEDICAL GROUP DERMATOLOGIC SPECIALTIES |
| Entity Type | Organization |
| Authorized Contact | KEENAN B FREEMAN CFO 503-893-6524 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X |
| Additional Taxonomies | 207N00000X Dermatology |
| 207ND0101X Dermatology, MOHS-Micrographic Surgery | |
| Enumeration Date | 2007-06-27 |
| Last Update Date | 2016-01-22 |