Individual
MANOHAR MULKI PUNJA
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
24900 SE STARK ST, SUITE 103, GRESHAM, OR 97030-3355
(503) 665-4278
(503) 665-7766
Mailing address
975 SE SANDY BLVD, SUITE 200, PORTLAND, OR 97214-1308
(503) 963-2846
(503) 963-9505
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
MD08438
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1089895
—
WA
05
—
150698
—
OR
Enumeration date
08/22/2005
Last updated
07/09/2007
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