Individual
SAMUEL M SHALES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3101 SW SAM JACKSON PARK ROAD, PORTLAND, OR 97239
(503) 221-3424
(503) 221-3490
Mailing address
3101 SW SAM JACKSON PARK ROAD, PORTLAND, OR 97239
(503) 221-3424
(503) 221-3490
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
OR
Other
Enumeration date
05/15/2019
Last updated
01/03/2020
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