Individual
COLIN M MCDONOUGH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D
Contact information
Practice address
1899 BLANKENSHIP RD, WEST LINN, OR 97068-4118
(503) 513-3350
Mailing address
PO BOX 3158, PORTLAND, OR 97208-3158
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
MD17459
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
037767
—
OR
01
—
P00824683
RR MEDICARE - PH&S
OR
Enumeration date
10/04/2006
Last updated
02/05/2013
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