Individual
JOHN RODGERS BRADDOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
4000 KRUSE WAY PL, BUILDING 2, SUITE 160, LAKE OSWEGO, OR 97035-5545
(503) 635-1960
(503) 635-8354
Mailing address
4000 KRUSE WAY PL, BUILDING 2, SUITE 160, LAKE OSWEGO, OR 97035-5545
(503) 635-1960
(503) 635-8354
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
MD09593
OR
2083P0500X
Preventive Medicine/Occupational Environmental Medicine Physician
Primary
MD09593
OR
Other
Enumeration date
02/01/2007
Last updated
11/15/2011
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