Individual
DR. PRISCILLA JANE WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
233 NE 102ND AVE, PORTLAND, OR 97220
(503) 535-8325
(503) 535-8399
Mailing address
233 NE 102ND AVE, PORTLAND, OR 97220-4106
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
MD175728
OR
Other
Enumeration date
08/31/2006
Last updated
08/26/2015
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