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Individual

MICHAEL VAN WYNGARDEN

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
PHYSICIAN ASSISTANT

Contact information

Practice address
3303 S BOND AVE, PORTLAND, OR 97239-4501
(503) 494-5058
(503) 494-3465
Mailing address
1400 SW 5TH AVE STE 500, PORTLAND, OR 97201-5537
(866) 617-6855
(503) 346-8015

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
PA.0007421
CO
363AM0700X
Medical Physician Assistant
Primary
PA223530
OR

Other

Enumeration date
02/23/2021
Last updated
03/11/2025
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