# WILLAMETTE VALLEY IMMUNOLOGY CENTER PC

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

## Provider details

- **NPI number:** 1952622508
- **Authorized official:** DR. THOMAS JEFFERSON SADDORIS II M.D. (PHYSICIAN OWNER)
- **Authorized official phone:** (503) 262-7273

## Contact information

- **Practice address:** 169 NE 102ND AVE, PORTLAND, OR 97220-4169
- **Practice address phone:** (503) 262-7273
- **Practice address fax:** (503) 262-7274
- **Mailing address:** 169 NE 102ND AVE, PORTLAND, OR 97220-4169
- **Mailing address phone:** (503) 262-7273
- **Mailing address fax:** (503) 262-7274

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207R00000X | Internal Medicine Physician | MD10197 | OR | Yes |

## Other

- **Enumeration date:** 06/17/2010
- **Last updated:** 06/17/2010