Individual
MR. SCOT SHOICHI ITOMURA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
17704 JEAN WAY, STE 101, LAKE OSWEGO, OR 97035-5497
(503) 699-0370
Mailing address
1013 SW GAINES ST, PORTLAND, OR 97239-2975
(503) 721-0828
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA01184
OR
Other
Enumeration date
02/26/2007
Last updated
07/08/2007
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