Organization
DERMATOLOGY BY DESIGN LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. OMAR QUTUB MD (OWNER)
(503) 705-2331
Entity
Organization
Contact information
Practice address
1129 NW 11TH AVE, PORTLAND, OR 97209-3469
(503) 705-2331
Mailing address
949 NW OVERTON ST UNIT 608, PORTLAND, OR 97209-3270
(503) 705-2331
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
MD158125
OR
Other
Enumeration date
02/21/2018
Last updated
02/21/2018
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