Individual
JEFF WAKEHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
4101 NE DIVISION ST, SUITE # 100, GRESHAM, OR 97030-4617
(503) 666-3808
(503) 666-6835
Mailing address
7540 CHAROLAIS CT, GLADSTONE, OR 97027-1259
(503) 557-7903
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Enumeration date
10/26/2007
Last updated
10/26/2007
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