Physician On Duty | |
14805 Sw Blanton St. Beaverton OR 97007 | |
(503) 957-9632 | |
Not Available |
Full Name | Physician On Duty |
---|---|
Speciality | General Practice |
Location | 14805 Sw Blanton St., Beaverton, Oregon |
Authorized Official Name and Position | Sandra L Jolly (BILLING MANAGER) |
Authorized Official Contact | 5037264685 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
---|---|
Physician On Duty 14805 Sw Blanton St. Beaverton OR 97007 Ph: (503) 957-9632 | Physician On Duty 14805 Sw Blanton St. Beaverton OR 97007 Ph: (503) 957-9632 |
NPI Number | 1275787780 |
---|---|
Provider Enumeration Date | 11/11/2008 |
Last Update Date | 11/11/2008 |
Identifier | Type | State | Issuer |
---|---|---|---|
1275787780 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
208D00000X | General Practice | (* (Not Available)) | Primary |
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