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Organization

TANASBOURNE FAMILY MEDICINE LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. CRAIG GILPIN MYERS M.D. (OWNER)
(503) 614-8400
Entity
Organization

Contact information

Practice address
17200 NW CORRIDOR CT, STE 105, BEAVERTON, OR 97006-3295
(503) 614-8400
(503) 614-8411
Mailing address
17200 NW CORRIDOR CT, STE 105, BEAVERTON, OR 97006-3295
(503) 614-8400
(503) 614-8411

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD15139
OR

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
154344
OR
Enumeration date
12/19/2006
Last updated
02/08/2008
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