Provider Demographics
NPI:1669646717
Name:SELLWOOD FAMILY MEDICINE
Entity Type:Organization
Organization Name:SELLWOOD FAMILY MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF MEDICAL OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:DANIEL
Authorized Official - Last Name:CHAPMAN
Authorized Official - Suffix:
Authorized Official - Credentials:ND
Authorized Official - Phone:503-233-8113
Mailing Address - Street 1:1567 SE TACOMA ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97202-6643
Mailing Address - Country:US
Mailing Address - Phone:503-233-8113
Mailing Address - Fax:
Practice Address - Street 1:1567 SE TACOMA ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97202-6643
Practice Address - Country:US
Practice Address - Phone:503-233-8113
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-19
Last Update Date:2008-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1345207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty