Individual
JOHN MCANULTY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1040 NW 22ND AVE, SUITE 660, PORTLAND, OR 97210
(503) 413-7162
(503) 413-7148
Mailing address
PO BOX 3777, PORTLAND, OR 97208-3777
(503) 413-3900
(503) 413-3710
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
MD09170
OR
207RC0000X
Cardiovascular Disease Physician
Primary
MD09170
OR
207RC0001X
Clinical Cardiac Electrophysiology Physician
9170
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
125849
—
OR
Enumeration date
06/23/2006
Last updated
06/10/2019
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