Individual
MR. BRANDON ELLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMT
Contact information
Practice address
7085 N CAMBRIDGE AVE, PORTLAND, OR 97203-4715
(503) 285-6320
Mailing address
7085 N CAMBRIDGE AVE, PORTLAND, OR 97203-4715
(503) 285-6320
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
12645
OR
Other
Enumeration date
04/28/2008
Last updated
04/28/2008
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