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Individual

DR. MICHAEL ROSS TANGUM

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
1015 NW 22ND AVE, PORTLAND, OR 97210-3025
(503) 413-7711
Mailing address
3566 NE ALAMEDA ST, PORTLAND, OR 97212-1808
(503) 282-7871

Taxonomy

Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
MD21239
OR

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
133977
OR
Enumeration date
02/15/2006
Last updated
09/06/2011
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