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MADISON PASCHAL BONHAM

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PA

Contact information

Practice address
4805 NE GLISAN ST STE 6N50, PORTLAND, OR 97213
(503) 215-2300
Mailing address
PO BOX 3158, PORTLAND, OR 97208-3158

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA182185
OR

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
500734044
OR
Enumeration date
04/01/2013
Last updated
08/19/2018
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