Organization
MT HOOD GENERAL AND VASCULAR SURGEONS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. DOREEN ROUSE (OFFICE MANAGER)
(503) 636-0776
Entity
Organization
Contact information
Practice address
17040 PILKINGTON RD, SUITE 208, LAKE OSWEGO, OR 97035-5587
(503) 636-0776
(503) 675-5101
Mailing address
17040 PILKINGTON RD, SUITE 208, LAKE OSWEGO, OR 97035-5587
(503) 661-4526
(503) 675-5101
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
MD11822
OR
2086S0129X
Vascular Surgery Physician
Primary
MD11807
OR
Other
Enumeration date
04/25/2007
Last updated
10/08/2012
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