Healthcare Provider Details

I. General information

NPI: 1356312425
Provider Name (Legal Business Name): MICHAEL G GARLAND PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/27/2006
Last Update Date: 04/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1508 DIVISION ST STE 105
OREGON CITY OR
97045-1584
US

IV. Provider business mailing address

1508 DIVISION ST STE 105
OREGON CITY OR
97045-1584
US

V. Phone/Fax

Practice location:
  • Phone: 503-656-0836
  • Fax: 503-656-9464
Mailing address:
  • Phone: 503-656-0836
  • Fax: 503-656-9464

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA00915
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA00915
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: