Individual
MR. JOHN EDWARD MULLIGAN IV
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRM
Contact information
Practice address
7916 SE FOSTER RD STE 201, PORTLAND, OR 97206-4289
(503) 465-2749
Mailing address
PO BOX 16756, PORTLAND, OR 97292-0756
(971) 517-7043
(503) 208-2596
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
—
OR
Other
Enumeration date
12/04/2018
Last updated
12/04/2018
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