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Individual

GEORGE FUSSELL

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man

Contact information

Practice address
17720 NE HALSEY ST, PORTLAND, OR 97230-6734
(503) 654-7654
(503) 654-7333
Mailing address
3587 HEATHROW WAY, MEDFORD, OR 97504-4004
(541) 858-8170

Taxonomy

Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
153343
MA
2084P0800X
Psychiatry Physician
MD150159
OR

Other

Enumeration date
05/01/2006
Last updated
05/22/2017
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