Individual
MS. LESLIE DIANE GREGORY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.A.C
Contact information
Practice address
8332 SE 13TH AVE, PORTLAND, OR 97202-7102
(503) 595-9300
(503) 595-9301
Mailing address
8332 SE 13TH AVE, PORTLAND, OR 97202-7102
(503) 595-9300
(503) 595-9301
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA00823
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
268490
—
OR
Enumeration date
05/02/2006
Last updated
09/13/2010
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