Individual
LOUISE CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
2701 NW VAUGHN ST, SUITE 140, PORTLAND, OR 97210-5398
(503) 721-6800
Mailing address
2924 NE TILLAMOOK ST, PORTLAND, OR 97212
(503) 282-2847
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
MD00029505
WA
207Q00000X
Family Medicine Physician
Primary
OR MD19137
OR
Other
Enumeration date
10/05/2006
Last updated
07/08/2007
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