Individual
DALE FOSSATI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
9900 SE SUNNYSIDE RD, CLACKAMAS, OR 97015-9777
(503) 571-8240
Mailing address
9900 SE SUNNYSIDE RD, CLACKAMAS, OR 97015-9777
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
OR PA00125
OR
Other
Enumeration date
08/16/2006
Last updated
07/14/2007
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