Individual
GINA MARIE CALLAWAY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT 17789
Contact information
Practice address
11501 SW PACIFIC HWY STE 100, TIGARD, OR 97223-8649
(503) 862-7787
Mailing address
11501 SW PACIFIC HWY STE 100, TIGARD, OR 97223-8649
(503) 862-7787
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
LMT 17789
OR
Other
Enumeration date
01/17/2011
Last updated
01/30/2024
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