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Organization
MT HOOD GENERAL AND VASCULAR SURGEONS LLC
Active
Organization
MT HOOD GENERAL AND VASCULAR SURGEONS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. DOREEN ROUSE (OFFICE MANAGER)
(503) 636-0776
Entity
Organization
Contact information
Practice address
17040 PILKINGTON RD, SUITE 208, LAKE OSWEGO, OR 97035-5587
(503) 636-0776
(503) 675-5101
Mailing address
17040 PILKINGTON RD, SUITE 208, LAKE OSWEGO, OR 97035-5587
(503) 661-4526
(503) 675-5101
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
MD11822
OR
2086S0129X
Vascular Surgery Physician
Primary
MD11807
OR
Other
Enumeration date
04/25/2007
Last updated
10/08/2012
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