Individual
DR. CHARLES NORVAL DE LEEUW
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD/MS, PHD
Contact information
Practice address
3181 SW SAM JACKSON PARK ROAD, PORTLAND, OR 97239
(503) 494-8211
Mailing address
3181 SW SAM JACKSON PARK RD, PORTLAND, OR 97239-3098
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
03/23/2020
Last updated
03/23/2020
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