Organization
MODERN NOSE CLINIC LLC
Active
Other names
Modern Nose Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
DOUGLAS J SKARADA MD (MEDICAL DIRECTOR)
(503) 584-1174
Entity
Organization
Contact information
Practice address
340 VISTA AVE SE, STE 100, SALEM, OR 97302
(503) 584-1174
(503) 584-1330
Mailing address
340 VISTA AVE SE, STE 100, SALEM, OR 97302
(503) 584-1174
(503) 584-1330
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
23186
OR
207Y00000X
Otolaryngology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
287190
—
OR
Enumeration date
04/19/2017
Last updated
05/02/2022
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