Registry details
Type
Individual
Primary specialty
Dermatology, Dermatopathology
Enumerated
May 4, 2017
License(s)
MD215961 (OR), 52535 (AL)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| MAILING | 5301 VIRGINIA WAY STE 300 | Brentwood, TN 37027-7542 | 615-221-4400 |
| LOCATION | 3303 S BOND AVE | Portland, OR 97239-4501 | 503-418-3376 |
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