| Cedar Creek Internal Medicine,pc | |
|
10200 Sw Eastridge St Ste 205 Portland OR 97225-5064 | |
| (503) 280-4555 | |
| (503) 280-4559 |
| Full Name | Cedar Creek Internal Medicine,pc |
|---|---|
| Speciality | Internal Medicine |
| Location | 10200 Sw Eastridge St, Portland, Oregon |
| Authorized Official Name and Position | Bradley J Fancher (PRESIDENT) |
| Authorized Official Contact | 5032804555 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Cedar Creek Internal Medicine,pc 10200 Sw Eastridge St Ste 205 Portland OR 97225-5064 Ph: (503) 280-4555 | Cedar Creek Internal Medicine,pc 10200 Sw Eastridge St Ste 205 Portland OR 97225-5064 Ph: (503) 280-4555 |
| NPI Number | 1265517437 |
|---|---|
| Provider Enumeration Date | 10/26/2006 |
| Last Update Date | 11/13/2012 |
| Medicare PECOS PAC ID | 6103816707 |
|---|---|
| Medicare Enrollment ID | O20040515000138 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1265517437 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | Duc Hoai Nguyen |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1275565814 PECOS PAC ID: 6406838556 Enrollment ID: I20040603000203 |
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