Organization
CEDAR CREEK INTERNAL MEDICINE,PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRADLEY J FANCHER MD (PRESIDENT)
(503) 280-4555
Entity
Organization
Contact information
Practice address
10200 SW EASTRIDGE ST, STE 205, PORTLAND, OR 97225-5064
(503) 280-4555
(503) 280-4559
Mailing address
10200 SW EASTRIDGE ST, STE 205, PORTLAND, OR 97225-5064
(503) 280-4555
(503) 280-4559
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Enumeration date
10/26/2006
Last updated
11/13/2012
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