Organization
NORTHWEST INTERNAL MEDICINE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. TANA MARIE HAYNES MD (PRESIDENT)
(503) 329-1851
Entity
Organization
Contact information
Practice address
19260 SW 65TH AVE STE 270, TUALATIN, OR 97062-5705
(503) 329-1851
(503) 885-8946
Mailing address
PO BOX 869, TUALATIN, OR 97062-0869
(503) 329-1851
(503) 885-8946
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
MD24660
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
029123
—
OR
Enumeration date
03/13/2007
Last updated
12/02/2014
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