Individual
IAN DOUGHERTY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
2037 N WILLIAMS AVE, PORTLAND, OR 97227-1929
(503) 287-3813
Mailing address
375 NE SHAVER ST APT 608, PORTLAND, OR 97212-1080
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
18078
OR
Other
Enumeration date
01/11/2013
Last updated
01/11/2013
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