Graduated: 2002
NPI: 1326109455
Practice Locations (3)
POCATELLO HEALTH SERVICES LLC
777 HOSPITAL WAY
POCATELLO, ID 832015175
2082391720
LEGACY EMANUEL HOSPITAL AND HEALTH CENTER
1225 NE 2ND AVE
PORTLAND, OR 972322003
5039448000
PEACEHEALTH MEDICAL GROUP
3333 RIVERBEND DR
SPRINGFIELD, OR 974778800
5412226000
Source: CMS National Downloadable File, September 2026.