Individual
JESSE MCELWAIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1605 NE BROADWAY, PORTLAND, OR 97211
(303) 547-7618
Mailing address
1605 NE BROADWAY, PORTLAND, OR 97211
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
18157
OR
Other
Enumeration date
10/31/2012
Last updated
10/31/2012
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