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General NPI Number Information
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NPI Number | 1902144298
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Entity Type | Organization
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Legal Business Name | KIDS FIRST PEDIATRIC CLINIC LLC
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Dates
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Enumeration Date | 01/22/2013
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Last Update Date | 01/22/2013
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Provider Practice Location Address
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Address Line | 18603 WILLAMETTE DR
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City | WEST LINN
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State | OR
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Zip | 97068-1705
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Country | US
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Telephone | 503-730-1634
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Fax |
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Provider Business Mailing Address
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Address Line | 18603 WILLAMETTE DR
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City | WEST LINN
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State | OR
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Zip | 97068-1705
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER/MD
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Name | BADIA JABBOUR
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Credential | MD
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Telephone | 503-730-1634
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | MD28575
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License Number State | OR
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