# MT HOOD GENERAL AND VASCULAR SURGEONS LLC

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

## Provider details

- **NPI number:** 1710106687
- **Authorized official:** MRS. DOREEN ROUSE (OFFICE MANAGER)
- **Authorized official phone:** (503) 636-0776

## Contact information

- **Practice address:** 17040 PILKINGTON RD, SUITE 208, LAKE OSWEGO, OR 97035-5587
- **Practice address phone:** (503) 636-0776
- **Practice address fax:** (503) 675-5101
- **Mailing address:** 17040 PILKINGTON RD, SUITE 208, LAKE OSWEGO, OR 97035-5587
- **Mailing address phone:** (503) 661-4526
- **Mailing address fax:** (503) 675-5101

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208600000X | Surgery Physician | MD11822 | OR | — |
| 2086S0129X | Vascular Surgery Physician | MD11807 | OR | Yes |

## Other

- **Enumeration date:** 04/25/2007
- **Last updated:** 10/08/2012