Individual
MR. LARRY ALLEN PADDOCK JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CSFA
Contact information
Practice address
2700 SE STRATUS AVE, MCMINNVILLE, OR 97128-6239
(503) 435-6580
Mailing address
2700 SE STRATUS AVE, MCMINNVILLE, OR 97128-6239
(503) 435-6580
Taxonomy
Speciality
Code
Description
License number
State
246ZC0007X
Surgical Assistant
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
199390
NATIONAL BOARD OF SURGICAL TECHNOLOGY AND SURGICAL ASSISTING
—
Enumeration date
02/10/2021
Last updated
02/10/2021
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