Organization
LAKE MEDICAL CLINIC, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
EDWARD E CONRAD JR. MD (VICE PRESIDENT)
(503) 635-5044
Entity
Organization
Contact information
Practice address
550 3RD ST, LAKE OSWEGO, OR 97034-3002
(503) 635-5044
(503) 635-3255
Mailing address
PO BOX 365, LAKE OSWEGO, OR 97034-0042
(503) 635-5044
(503) 635-3255
Taxonomy
Speciality
Code
Description
License number
State
261QM2500X
Medical Specialty Clinic/Center
Primary
12913
OR
Other
Enumeration date
09/23/2006
Last updated
08/22/2020
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