# CEDAR CREEK INTERNAL MEDICINE,PC

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

## Provider details

- **NPI number:** 1265517437
- **Authorized official:** BRADLEY J FANCHER MD (PRESIDENT)
- **Authorized official phone:** (503) 280-4555

## Contact information

- **Practice address:** 10200 SW EASTRIDGE ST, STE 205, PORTLAND, OR 97225-5064
- **Practice address phone:** (503) 280-4555
- **Practice address fax:** (503) 280-4559
- **Mailing address:** 10200 SW EASTRIDGE ST, STE 205, PORTLAND, OR 97225-5064
- **Mailing address phone:** (503) 280-4555
- **Mailing address fax:** (503) 280-4559

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207R00000X | Internal Medicine Physician | — | NULL | Yes |
| 207R00000X | Internal Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 10/26/2006
- **Last updated:** 11/13/2012