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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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