Individual
FRED MCLANE BRUDERLIN JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
5211 NE GLISAN ST BLDG C, PORTLAND, OR 97213-3052
(503) 704-6658
Mailing address
515 ATWATER RD, LAKE OSWEGO, OR 97034-2115
(503) 704-6658
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
—
OR
172V00000X
Community Health Worker
Primary
—
—
Other
Enumeration date
01/22/2018
Last updated
01/22/2018
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