Individual
TRAVIS A GATERS III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
7624 N PORTSMOUTH AVE, PORTLAND, OR 97203-5954
(503) 317-6762
Mailing address
7624 N PORTSMOUTH AVE, PORTLAND, OR 97203-5954
(503) 317-6762
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Enumeration date
08/27/2019
Last updated
08/27/2019
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