Individual
DR. PAUL E VANBREDAVRIESMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
18000 SE STARK STREET, GRESHAM, OR 97233
(503) 255-4243
(503) 255-4243
Mailing address
16244 NE SAN RAFAEL DR, 18000 SE STARK STREET, PORTLAND, OR 97230-5661
(503) 255-4243
(503) 255-4243
Taxonomy
Speciality
Code
Description
License number
State
207QA0505X
Adult Medicine Physician
Primary
MD11073
OR
Other
Enumeration date
04/14/2009
Last updated
04/14/2009
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