Individual
BO MALAYTHONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2073 OLYMPIC ST, SPRINGFIELD, OR 97477-3413
(541) 682-3550
Mailing address
4655 CODY AVE, EUGENE, OR 97402-1254
(541) 968-7962
Taxonomy
Speciality
Code
Description
License number
State
163WC1500X
Community Health Registered Nurse
Primary
TBD
OR
Other
Enumeration date
08/15/2016
Last updated
08/15/2016
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