Individual
GINGER L DEGRAVELLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
10000 SE MAIN ST STE 112, PORTLAND, OR 97216-2441
(503) 255-3054
(503) 255-7651
Mailing address
10000 SE MAIN ST STE 112, PORTLAND, OR 97216-2441
(503) 255-3054
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
MD217089
OR
207RG0100X
Gastroenterology Physician
Primary
MD217089
OR
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
05/01/2017
Last updated
12/19/2023
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