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Physicians Dermatology

Provider NPI: 1083653653

Provider Information:
Gender: M
Not Sole Proprietor

Practice Location:
5330 NE GLISAN ST. SUITE 200 PORTLAND, OR 97213-3069 US
Tel: 503-215-9080  Fax: 503-215-9099

Business Mailing Address:
PO BOX 3158  PORTLAND, OR 97208-3159 US
Tel: 503-215-6494  Fax: 503-215-6644

NPI Information:
NPI: 1083653653
Entity Type: Individual


PrimaryCodeCategory/DescriptionStateLicense Number

Other Provider Identifiers:


American Medical Association 2012 taxonomy code information

Code: 207N00000X





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