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Individual

MR. IAN CLEMONS

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
PA-C

Contact information

Practice address
3500 N INTERSTATE AVE, EMERGICENTER, PORTLAND, OR 97227-1196
(503) 331-6101
Mailing address
724 SE 27TH AVE, PORTLAND, OR 97214-3009
(503) 238-5097

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA00692
OR

Other

Enumeration date
09/20/2006
Last updated
07/08/2007
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