Healthcare Provider Details

I. General information

NPI: 1982880761
Provider Name (Legal Business Name): LEE GARDNER M D L L C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2008
Last Update Date: 04/01/2026
Certification Date: 04/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10245 NW GLENCOE RD
NORTH PLAINS OR
97133-8233
US

IV. Provider business mailing address

10245 NW GLENCOE RD
NORTH PLAINS OR
97133-8233
US

V. Phone/Fax

Practice location:
  • Phone: 503-647-9261
  • Fax: 503-647-1230
Mailing address:
  • Phone: 503-647-9261
  • Fax: 503-647-1230

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: DR. MARION LEE GARDNER JR.
Title or Position: OWNER
Credential: MD
Phone: 503-647-9261