Individual
TRACY DODGE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C, MPH
Contact information
Practice address
727 W BURNSIDE ST, PORTLAND, OR 97209-3514
(503) 228-4533
Mailing address
727 W BURNSIDE ST, PORTLAND, OR 97209-3514
(503) 228-4533
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA190591
OR
Other
Enumeration date
10/04/2016
Last updated
07/11/2019
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