MR. John Mccollum

NPI #1083036073 in Portland, Oregon

Provider Information

NPI Number: 1083036073
Entity Type: Individual
Name: MR. John Mccollum
Gender: Not Specified
Sole Proprietor: Yes
Primary Specialty: Specialist
Enumeration Date: Jan 10, 2014
Last Updated: Jan 10, 2014

Practice Location

Address: 4259 NE BROADWAY ST
City: Portland
State: Oregon
ZIP Code: 97213-1421
Phone: (503) 358-3506

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Specialist	174400000X	Primary

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