Organization
FANNO CREEK CLINIC LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LARRY M REED (CLINIC MANAGER)
(503) 452-0915
Entity
Organization
Contact information
Practice address
2400 SW VERMONT ST, PORTLAND, OR 97219-1940
(503) 452-0915
(503) 768-9232
Mailing address
2400 SW VERMONT ST, PORTLAND, OR 97219-1940
(503) 452-0915
(503) 768-9232
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
2802
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
151070
—
OR
Enumeration date
07/29/2005
Last updated
10/16/2007
Update your record
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