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General NPI Number Information
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NPI Number | 1366699464
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Entity Type | Organization
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Legal Business Name | THE OREGON CLINIC PC
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Dates
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Enumeration Date | 08/20/2008
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Last Update Date | 10/30/2024
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Provider Practice Location Address
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Address Line | 315 SE STONEMILL DR SUITE 220
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City | VANCOUVER
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State | WA
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Zip | 98684-6998
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Country | US
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Telephone | 503-963-2707
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Fax | 503-963-2802
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Provider Business Mailing Address
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Address Line | 541 NE 20TH AVE STE 225
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City | PORTLAND
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State | OR
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Zip | 97232-2895
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Country | US
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Telephone | 503-963-2801
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Fax | 503-963-2825
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Authorized Official
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Title or Position | CEO PRESIDENT
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Name | RICHARD L JAMISON
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Credential | M.D.
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Telephone | 503-963-2801
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 160412
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License Number State | OR
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