Organization
PEDIATRIC ENDOCRINOLOGY OF PORTLAND, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DALE MICHAEL WILLIS MD, PHD (PRESIDENT)
(503) 206-3636
Entity
Organization
Contact information
Practice address
9155 SW BARNES RD, SUITE 931, PORTLAND, OR 97225-6625
(503) 206-3636
(503) 206-3635
Mailing address
9155 SW BARNES RD, SUITE 931, PORTLAND, OR 97225-6625
(503) 206-3636
(503) 206-3635
Taxonomy
Speciality
Code
Description
License number
State
2080P0205X
Pediatric Endocrinology Physician
Primary
MD22738
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
287841
—
OR
Enumeration date
05/10/2007
Last updated
08/22/2020
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