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Geriatric Medicine >> Internal Medicine >> Allopathic & Osteopathic Physicians

Registrant NPI Number: 1992898704

Individual Registrant:
Gender: M
Not Sole Proprietor

Location and contact information for practice:
Tel: 907-212-3420  Fax: 907-212-3429

Contact information for business:
PO BOX 4105  PORTLAND, OR 97208-4105 US
Tel: 866-907-1068  Fax: 425-917-9141

Registration Information:
NPI: 1992898704
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
Y207RG0300XAllopathic & Osteopathic Physicians
Internal Medicine
Geriatric Medicine

Legacy codes, insurance codes and state license numbers:



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