Individual
MICHAEL RYAN GRAWCOCK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMT
Contact information
Practice address
4318 SW DICKINSON ST, PORTLAND, OR 97219-7456
(503) 806-6671
Mailing address
4318 SW DICKINSON ST, PORTLAND, OR 97219-7456
(503) 806-6671
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
13981
OR
Other
Enumeration date
05/10/2010
Last updated
05/10/2010
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