Individual
JOHN G MICKELSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
2930 NE WEST DEVILS LAKE RD STE 3, LINCOLN CITY, OR 97367-5195
(541) 557-6427
Mailing address
PO BOX 1189, CORVALLIS, OR 97339-1189
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
34645
MN
207Q00000X
Family Medicine Physician
Primary
DO226460
OR
2083X0100X
Occupational Medicine Physician
6205
ND
Other
Enumeration date
07/18/2006
Last updated
09/04/2025
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