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Organization
GRESHAM PODIATRY CENTER, LLC
Active
Organization
GRESHAM PODIATRY CENTER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DEREK JOHN MCCAMMON D.P.M. (OWNER)
(503) 667-6600
Entity
Organization
Contact information
Practice address
831 NW COUNCIL DR, SUITE #203, GRESHAM, OR 97030-3721
(503) 667-6600
(503) 667-6608
Mailing address
831 NW COUNCIL DR, SUITE #203, GRESHAM, OR 97030-3721
(503) 667-6600
(503) 667-6608
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
307
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1891742318
GROUP NPI
OR
Enumeration date
05/28/2006
Last updated
04/02/2008
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