Organization
INHOUSEDOC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROBERT JOHN TILLEY M.D. (OWNER)
(503) 974-6170
Entity
Organization
Contact information
Practice address
12720 SW PACIFIC HWY STE 1, TIGARD, OR 97223-6125
(503) 974-6170
(503) 208-7198
Mailing address
12720 SW PACIFIC HWY STE 1, TIGARD, OR 97223-6125
(503) 974-6170
(503) 208-7198
Taxonomy
Speciality
Code
Description
License number
State
261QH0100X
Health Service Clinic/Center
Primary
14698
OR
Other
Enumeration date
09/02/2014
Last updated
09/02/2014
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