Organization
MT. TABOR FAMILY MEDICAL GROUP, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. LORI E NIES (CLINIC MANAGER)
(503) 234-7366
Entity
Organization
Contact information
Practice address
5919 SE BELMONT ST, PORTLAND, OR 97215-1925
(503) 234-7366
(503) 234-8928
Mailing address
5919 SE BELMONT ST, PORTLAND, OR 97215-1925
(503) 234-7366
(503) 234-8928
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
—
Other
Enumeration date
10/06/2006
Last updated
03/01/2013
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