Cedar Creek Internal Medicine,pc

NPI #1265517437 in Portland, Oregon

Provider Information

NPI Number: 1265517437
Entity Type: Organization
Organization Name: Cedar Creek Internal Medicine,pc
Primary Specialty: Internal Medicine
Enumeration Date: Oct 26, 2006
Last Updated: Nov 13, 2012

Practice Location

Address: 10200 SW EASTRIDGE ST
Address 2: STE 205
City: Portland
State: Oregon
ZIP Code: 97225-5064
Phone: (503) 280-4555

Authorized Official

Name: BRADLEY J FANCHER, MD
Title: PRESIDENT
Phone: (503) 280-4555

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Internal Medicine	207R00000X	Primary

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