Graduated: 2022
NPI: 1558873547
Practice Locations (2)
LEGACY CLINICS LLC
2801 N GANTENBEIN AVE
PORTLAND, OR 972271623
5034132200
LEGACY EMANUEL HOSPITAL AND HEALTH CENTER
300 N GRAHAM ST, SUITE 300
PORTLAND, OR 972271666
5034133030
Source: CMS National Downloadable File, September 2026.