Organization
THE MEDICAL WELLNESS CLINIC, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
STEPHEN A WEIL MD (CLINIC DIRECTOR)
(503) 697-3001
Entity
Organization
Contact information
Practice address
4035 MERCANTILE DR, SUITE 101, LAKE OSWEGO, OR 97035-2546
(503) 697-3001
(503) 697-0906
Mailing address
4035 MERCANTILE DR, SUITE 101, LAKE OSWEGO, OR 97035-2546
(503) 697-3001
(503) 697-0906
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
MD07794
OR
Other
Enumeration date
09/28/2007
Last updated
09/28/2007
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