Individual
BLAIR PETERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
3181 SW SAM JACKSON PARK RD # L352A, PORTLAND, OR 97239-3011
(503) 494-7824
Mailing address
3181 SW SAM JACKSON PARK RD # L352A, PORTLAND, OR 97239-3011
(503) 494-7824
Taxonomy
Speciality
Code
Description
License number
State
208200000X
Plastic Surgery Physician
Primary
2019011349
MO
2086S0122X
Plastic and Reconstructive Surgery Physician
197514
OR
Other
Enumeration date
07/29/2019
Last updated
04/28/2021
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