# WONDERFUL MEDICAL GROUP PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1154914232
- **Authorized official:** DR. JEFFREY LEE KATZ MD (PRESIDENT)
- **Authorized official phone:** (508) 404-9910

## Contact information

- **Practice address:** 920 SW 6TH AVE STE 1200, PORTLAND, OR 97204-1212
- **Practice address phone:** (503) 208-4116
- **Practice address fax:** (503) 213-6510
- **Mailing address:** PO BOX 1714, BEAVERTON, OR 97075-1714
- **Mailing address phone:** (503) 208-4116
- **Mailing address fax:** (503) 213-6510

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 02/19/2021
- **Last updated:** 07/25/2021