Individual
MICHAEL (BRIAN) BRIAN FENNERTY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3181 SW SAM JACKSON PARK RD, MAIL CODE L461, PORTLAND, OR 97239-3011
(503) 494-8577
Mailing address
3181 SW SAM JACKSON PARK RD, OHSU DIVISION OF GASTROENTEROLOGY, MAIL CODE L461, PORTLAND, OR 97239-3011
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
MD18698
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
062976
—
OR
Enumeration date
07/31/2006
Last updated
07/10/2007
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