# BRYAN D. WALLS, D.O. P.C.

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Hawthorne Family Medicine
- **Organization subpart:** No

## Provider details

- **NPI number:** 1467601096
- **Authorized official:** MR. BRYAN DEAN WALLS D.O. (PHYSICIAN)
- **Authorized official phone:** (503) 963-9181

## Contact information

- **Practice address:** 2306 SE 39TH AVE, PORTLAND, OR 97214-5918
- **Practice address phone:** (503) 963-9181
- **Practice address fax:** (503) 963-9182
- **Mailing address:** 2306 SE 39TH AVE, PORTLAND, OR 97214-5918
- **Mailing address phone:** (503) 963-9181
- **Mailing address fax:** (503) 963-9182

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | DO20625 | OR | Yes |

## Other

- **Enumeration date:** 09/18/2008
- **Last updated:** 09/18/2008