Healthcare Provider Details

I. General information

NPI: 1174764864
Provider Name (Legal Business Name): GARY W OSWALD LAC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/10/2009
Last Update Date: 03/10/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11385 SW SCHOLLS FERRY RD
BEAVERTON OR
97008-7167
US

IV. Provider business mailing address

234 SE 43RD AVE
HILLSBORO OR
97123-5915
US

V. Phone/Fax

Practice location:
  • Phone: 503-747-9618
  • Fax:
Mailing address:
  • Phone: 503-747-9618
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC01276
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: