Individual
DONTAE EUGENE MATHIS SR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
124 E HISTORIC COLUMBIA RIVER HWY, TROUTDALE, OR 97060
(971) 293-9237
Mailing address
3854 SW CULLEN BLVD, PORTLAND, OR 97221-3528
(971) 263-7239
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
08/31/2022
Last updated
08/31/2022
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