Individual
SAM DAVID GILLAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2410 SE 121ST AVE, PORTLAND, OR 97216-4066
(503) 335-5975
Mailing address
5815 SW 59TH CT, PORTLAND, OR 97221-1062
(503) 334-6205
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Enumeration date
05/20/2008
Last updated
05/20/2008
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