Individual
NICHOLAS BEACH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
24800 SE STARK ST, GRESHAM, OR 97030-3378
(503) 413-8407
(503) 413-6951
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
Primary
DO176517
OR
Other
Enumeration date
04/08/2013
Last updated
06/09/2016
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