Individual
DR. DALE MICHAEL WILLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
9155 SW BARNES RD, SUITE 931, PORTLAND, OR 97225-6636
(503) 216-6050
Mailing address
PO BOX 3158, PORTLAND, OR 97208-3158
Taxonomy
Speciality
Code
Description
License number
State
2080P0205X
Pediatric Endocrinology Physician
Primary
MD22738
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
287841
—
OR
Enumeration date
03/28/2006
Last updated
03/04/2015
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