Organization
CHILDRENS CLINIC PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KELSEY DURHAM (HEALTH PLAN COORDINATOR)
(503) 535-6314
Entity
Organization
Contact information
Practice address
19260 SW 65TH AVE, STE 340, TUALATIN, OR 97062-5701
(503) 691-9777
(503) 692-6736
Mailing address
9555 SW BARNES RD, STE 301, PORTLAND, OR 97225-6663
(503) 297-3371
(503) 297-7975
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500730975
—
OR
Enumeration date
07/26/2007
Last updated
04/28/2020
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