Individual
MARK GRUDLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
X
Contact information
Practice address
10362 SW MCDONALD ST, TIGARD, OR 97224-4863
(971) 202-7964
Mailing address
1027 E BURNSIDE ST, PORTLAND, OR 97214-1328
(503) 239-8400
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
—
—
Other
Enumeration date
11/18/2025
Last updated
11/18/2025
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