Organization
SCHOLLS PEDIATRIC CLINIC LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RICHARD DEKLOTZ (OWNER)
(503) 579-3214
Entity
Organization
Contact information
Practice address
12442 SW SCHOLLS FERRY RD, #205, TIGARD, OR 97223-3396
(503) 579-3214
Mailing address
12442 SW SCHOLLS FERRY RD, #205, TIGARD, OR 97223-3396
Taxonomy
Speciality
Code
Description
License number
State
261QM2500X
Medical Specialty Clinic/Center
Primary
3542358
OR
Other
Enumeration date
01/18/2007
Last updated
08/25/2007
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