Individual
DR. DANIEL KEITH MANGUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
9900 SW HALL BLVD, #200, TIGARD, OR 97223
(503) 293-1515
(503) 595-3905
Mailing address
9900 SW HALL BLVD, #200, TIGARD, OR 97223
(503) 293-1515
(503) 595-3905
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
DO15821
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000625
—
OR
Enumeration date
12/01/2006
Last updated
07/08/2007
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