Maple Street Clinic, PC

NPI #1225066194 in Forest Grove, Oregon

Provider Information

NPI Number: 1225066194
Entity Type: Organization
Organization Name: Maple Street Clinic, PC
Primary Specialty: Family Medicine
Enumeration Date: Jun 29, 2006
Last Updated: Jan 10, 2013

Practice Location

Address: 1825 MAPLE ST
City: Forest Grove
State: Oregon
ZIP Code: 97116-1939
Phone: (503) 357-2136

Authorized Official

Name: MR. JOHN DAHLQUIST
Title: CLINIC ADMINISTRATOR
Phone: (503) 357-2136

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Family Medicine	207Q00000X	Primary

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