Individual
MITCHELL S BRANCH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CRM
Contact information
Practice address
1817 NE 6TH AVE, PORTLAND, OR 97212-3960
(503) 719-7985
(503) 994-5262
Mailing address
1817 NE 6TH AVE, PORTLAND, OR 97212-3960
(503) 719-7985
(503) 994-5262
Taxonomy
Speciality
Code
Description
License number
State
261QC1500X
Community Health Clinic/Center
Primary
22-CRM-1540
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
999999
—
OR
Enumeration date
01/24/2023
Last updated
01/24/2023
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