Organization
EVGENY I FEDOTOV
Active
Other names
north west clinical laboratory
Organization subpart
No
Provider details
NPI number
Authorized official
EVGENY I FEDOTOV (PRESIDENT)
(503) 252-5042
Entity
Organization
Contact information
Practice address
6629 NE 82ND AVE, SUITE 203, PORTLAND, OR 97220-1346
(503) 756-8159
Mailing address
6629 NE 82ND AVE, SUITE 203, PORTLAND, OR 97220-1346
(503) 756-8159
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
—
OR
Other
Enumeration date
08/08/2006
Last updated
08/22/2020
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