Organization
EASTMORELAND SURGICAL CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
WILLIAM MADORIN GRAHAM DO (OWNER)
(503) 232-2163
Entity
Organization
Contact information
Practice address
2804 SE STEELE ST # 2, PORTLAND, OR 97202-4525
(503) 232-2163
(503) 232-2164
Mailing address
PO BOX 610, FAIRVIEW, OR 97024-0610
(503) 963-1200
(425) 259-6300
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
8107633
DSHS
—
Enumeration date
07/03/2006
Last updated
08/04/2009
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