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Individual

MICHAEL BRUCE WYMAN

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
5050 NE HOYT ST, SUITE 340, PORTLAND, OR 97213-2991
(503) 234-9861
(503) 238-0873
Mailing address
5050 NE HOYT ST, PORTLAND, OR 97213-2991
(503) 234-9861
(503) 238-0873

Taxonomy

Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
MD13922
OR

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
202739
OR
Enumeration date
07/08/2005
Last updated
12/31/2007
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