Organization
PORTLAND DERMATOLOGY CLINIC, LLP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KATE A OTHUS MHA (ADMINISTRATOR)
(503) 445-2133
Entity
Organization
Contact information
Practice address
1414 NW NORTHRUP ST, SUITE 600, PORTLAND, OR 97209-2798
(503) 223-3104
(503) 223-4619
Mailing address
1414 NW NORTHRUP ST, SUITE 600, PORTLAND, OR 97209-2798
(503) 223-3104
(503) 223-4619
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
MD18952
OR
Other
Enumeration date
01/23/2007
Last updated
07/19/2010
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