Individual
LYLE BRUCE HAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3181 SW SAM JACKSON PARK RD, MC L611, PORTLAND, OR 97239-3011
(503) 494-5300
(503) 494-6519
Mailing address
3181 SW SAM JACKSON PARK RD, MC L611, PORTLAND, OR 97239-3011
(503) 494-5300
(503) 494-6519
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
MD10089
OR
2086S0102X
Surgical Critical Care Physician
MD10089
OR
Other
Enumeration date
10/23/2006
Last updated
01/19/2011
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