Individual
CALEB P PRENTICE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
1321 NE 99TH AVE STE 100, PORTLAND, OR 97220-9437
(503) 215-9900
Mailing address
PO BOX 3158, PORTLAND, OR 97208-3158
(503) 215-6494
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
DO207643
OR
207Q00000X
Family Medicine Physician
OS020159
PA
Other
Enumeration date
05/02/2016
Last updated
02/10/2023
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