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Individual

MASON D SPONG

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
PA-C

Contact information

Practice address
2701 NW VAUGHN ST STE 470, PORTLAND, OR 97210-5326
(503) 751-2216
(503) 296-2022
Mailing address
3265 NE ALBERTA ST, PORTLAND, OR 97211-7040
(985) 264-4859

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
214752
OR

Other

Enumeration date
01/30/2024
Last updated
05/30/2024
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