Provider Demographics
NPI:1679742217
Name:WILLAMETTE FALLS FAMILY MEDICINE
Entity Type:Organization
Organization Name:WILLAMETTE FALLS FAMILY MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:T
Authorized Official - Last Name:PHAM
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:503-657-3034
Mailing Address - Street 1:702 JOHN ADAMS ST
Mailing Address - Street 2:
Mailing Address - City:OREGON CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97045-1955
Mailing Address - Country:US
Mailing Address - Phone:503-657-3034
Mailing Address - Fax:503-657-1785
Practice Address - Street 1:702 JOHN ADAMS ST
Practice Address - Street 2:
Practice Address - City:OREGON CITY
Practice Address - State:OR
Practice Address - Zip Code:97045-1955
Practice Address - Country:US
Practice Address - Phone:503-657-3034
Practice Address - Fax:503-657-1785
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-28
Last Update Date:2009-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDO23388207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty