Medical school: UNIVERSITY OF TEXAS MEDICAL SCHOOL AT SAN ANTONIO
Graduated: 1989
NPI: 1982717583
Practice Locations (2)
PROVIDENCE HEALTH AND SERVICES OREGON
200 S HAZEL DELL WAY
CANBY, OR 970137829
2032639500
PROVIDENCE HEALTH AND SERVICES OREGON
5050 NE HOYT ST, SUITE 240
PORTLAND, OR 972132981
5032156480
Source: CMS National Downloadable File, September 2026.