Individual
KEVIN FARIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMT
Contact information
Practice address
7201 NE GLISAN ST, SUITE C, PORTLAND, OR 97213-6369
(503) 544-0467
Mailing address
7201 NE GLISAN ST, SUITE C, PORTLAND, OR 97213-6369
(503) 544-0467
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
21674
OR
Other
Enumeration date
10/29/2015
Last updated
10/29/2015
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