Individual
MICHAEL IRVIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
6010 SW SHATTUCK RD, PORTLAND, OR 97221-1043
(503) 246-8811
(503) 246-9557
Mailing address
1425 NE MASON ST, PORTLAND, OR 97211-5143
(503) 453-4996
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
09071
OR
Other
Enumeration date
07/21/2014
Last updated
07/21/2014
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