Individual
DR. EUGENE PENDLETON NICHOLSON IV
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3181 SW SAM JACKSON PARK RD, PORTLAND, OR 97239-3011
(503) 494-8311
Mailing address
707 SW GAINES ST, CDRC-P, PORTLAND, OR 97239-2901
(503) 418-5263
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
AE33090453635
OR
Other
Enumeration date
05/23/2007
Last updated
12/05/2008
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