Individual
JP PROUTY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2801 DAGGETT AVE, KLAMATH FALLS, OR 97601-7150
(541) 274-4510
Mailing address
3181 SW SAM JACKSON PARK RD, PORTLAND, OR 97239-3011
(503) 494-8211
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
M-13859
ID
Other
Enumeration date
04/09/2014
Last updated
09/13/2017
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