Provider Demographics
NPI:1215582861
Name:SNOW, JOSHUA GARDNER (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:MR
First Name:JOSHUA
Middle Name:GARDNER
Last Name:SNOW
Suffix:
Gender:M
Credentials:PHYSICIAN ASSISTANT
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Mailing Address - Street 1:PO BOX 3777
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97208-3777
Mailing Address - Country:US
Mailing Address - Phone:503-413-3900
Mailing Address - Fax:503-413-3710
Practice Address - Street 1:2850 SE POWELL VALLEY RD
Practice Address - Street 2:
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97080-1494
Practice Address - Country:US
Practice Address - Phone:503-666-5050
Practice Address - Fax:503-666-1162
Is Sole Proprietor?:No
Enumeration Date:2019-08-08
Last Update Date:2023-03-03
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Provider Licenses
StateLicense IDTaxonomies
UT11362623-1206363A00000X
ORPA195884363A00000X
WAPA61000072363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant