Individual
DENNIS NEIL BOURDETTE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3181 SW SAM JACKSON PARK RD, DEPARTMENT OF NEUROLOGY, L226, PORTLAND, OR 97239-3011
(503) 494-7772
Mailing address
10627 SW HOOD AVE, PORTLAND, OR 97219-7812
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
MD12086
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
267773
—
OR
Enumeration date
07/31/2006
Last updated
07/08/2007
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