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Individual

MR. DANIEL S MULLOOLY

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
LMT

Contact information

Practice address
4402 SE FLAVEL ST, PORTLAND, OR 97206-8428
(503) 781-4388
Mailing address
4402 SE FLAVEL ST, PORTLAND, OR 97206-8428
(503) 781-4388

Taxonomy

Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
13294 LMT
OR

Other

Enumeration date
09/16/2007
Last updated
01/15/2013
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