Individual
JONATHAN SAMUEL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D., M.P.H.
Contact information
Practice address
10180 SE SUNNYSIDE RD, CLACKAMAS, OR 97015-8970
(503) 652-2880
Mailing address
10180 SE SUNNYSIDE RD, CLACKAMAS, OR 97015-8970
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
2007-00921
NC
2086S0102X
Surgical Critical Care Physician
2007-00921
NC
Other
Enumeration date
04/25/2007
Last updated
10/10/2014
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