Individual
SAMUEL J FELLIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
12442 SW SCHOLLS FERRY RD, SUITE 106, TIGARD, OR 97223-3396
(503) 216-9200
(503) 212-6922
Mailing address
PO BOX 3158, PORTLAND, OR 97208-3158
(503) 215-6494
(503) 215-6644
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
DO16616
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
110101988
RR MEDICARE
OR
Enumeration date
07/05/2006
Last updated
10/15/2020
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