Individual
ANDRE MARTIN MANSOOR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3181 SW SAM JACKSON PARK RD, PORTLAND, OR 97239-3011
(503) 494-8211
Mailing address
12961 SE 129TH CT, HAPPY VALLEY, OR 97086-4335
(503) 957-6294
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
PG155758
OR
208M00000X
Hospitalist Physician
Primary
158366
OR
Other
Enumeration date
06/05/2009
Last updated
12/11/2013
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