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General NPI Number Information
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NPI Number | 1306052485
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Entity Type | Organization
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Legal Business Name | OSTEOPATHIC ADVANTAGE
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Dates
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Enumeration Date | 05/15/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 5331 SW MACADAM AVE SUITE 380
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City | PORTLAND
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State | OR
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Zip | 97239-6104
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Country | US
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Telephone | 503-230-2501
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Fax | 503-731-0454
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Provider Business Mailing Address
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Address Line | 5331 SW MACADAM AVE SUITE 380
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City | PORTLAND
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State | OR
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Zip | 97239-6104
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Country | US
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Telephone | 503-230-2501
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Fax | 503-731-0454
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Authorized Official
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Title or Position | OWNER
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Name | DR. ALFRED TURNER
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Credential | D.O.
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Telephone | 503-230-2501
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 118654
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License Number State | OR
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