Healthcare Provider Details

I. General information

NPI: 1235130857
Provider Name (Legal Business Name): NEWSTART PMR CLINIC, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2005
Last Update Date: 12/19/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10101 SE MAIN ST STE 2016
PORTLAND OR
97216-2457
US

IV. Provider business mailing address

10101 SE MAIN ST STE 2016
PORTLAND OR
97216-2457
US

V. Phone/Fax

Practice location:
  • Phone: 503-253-3882
  • Fax: 503-253-2848
Mailing address:
  • Phone: 503-253-3882
  • Fax: 503-253-2848

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberMD14393
License Number StateOR

VIII. Authorized Official

Name: DR. HAROLD G LEE
Title or Position: PRESIDENT
Credential: MD
Phone: 503-253-3882