Medical school: OREGON HEALTH SCIENCES UNIVERSITY SCHOOL OF MEDICINE
Graduated: 1975
NPI: 1124126636
Practice Locations (2)
FANNO CREEK CLINIC LLC
2400 SW VERMONT ST
PORTLAND, OR 972191940
5034520915
PROVIDENCE HEALTH AND SERVICES - OREGON
4805 NE GLISAN ST
PORTLAND, OR 972132933
5032151111
Source: CMS National Downloadable File, September 2026.