Organization
WILLAMETTE VALLEY IMMUNOLOGY CENTER PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. THOMAS JEFFERSON SADDORIS II M.D. (PHYSICIAN OWNER)
(503) 262-7273
Entity
Organization
Contact information
Practice address
169 NE 102ND AVE, PORTLAND, OR 97220-4169
(503) 262-7273
(503) 262-7274
Mailing address
169 NE 102ND AVE, PORTLAND, OR 97220-4169
(503) 262-7273
(503) 262-7274
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
MD10197
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
18374
—
OR
Enumeration date
06/17/2010
Last updated
06/17/2010
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