Individual
BENJAMIN CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CPO
Contact information
Practice address
17316 NE HALSEY ST, PORTLAND, OR 97230-6026
(503) 257-6623
Mailing address
17316 NE HALSEY ST, PORTLAND, OR 97230-6026
(503) 257-6623
Taxonomy
Speciality
Code
Description
License number
State
222Z00000X
Orthotist
—
—
224P00000X
Prosthetist
Primary
—
—
Other
Enumeration date
07/19/2011
Last updated
03/01/2018
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