Individual
JONATHAN SCOTT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMT
Contact information
Practice address
6880 SE DIVISION ST, PORTLAND, OR 97206-1269
(706) 676-7708
Mailing address
6880 SE DIVISION ST, PORTLAND, OR 97206-1269
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
19382
OR
Other
Enumeration date
12/07/2012
Last updated
12/07/2012
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