Individual
MR. FREDRIC M HARWIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MSC, BCO, BADO, FAMI
Contact information
Practice address
2525 NW LOVEJOY ST, STE 306, PORTLAND, OR 97210-2859
(503) 229-8490
(503) 224-0740
Mailing address
2525 NW LOVEJOY ST, STE 306, PORTLAND, OR 97210-2859
(503) 229-8490
(503) 224-0740
Taxonomy
Speciality
Code
Description
License number
State
156FX1700X
Ocularist
Primary
516802-89
OR
1744P3200X
Prosthetics Case Management
51680289
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01621900001
REGENCE BCBS DME SUPPLIER
OR
05
—
500605356
—
OR
Enumeration date
09/15/2005
Last updated
08/24/2011
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