Provider Demographics
NPI:1891025854
Name:WILLAMETTE MEDICAL LABS, INC.
Entity Type:Organization
Organization Name:WILLAMETTE MEDICAL LABS, INC.
Other - Org Name:AESTHETIC MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:DARM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:503-697-9777
Mailing Address - Street 1:9735 SW SHADY LN STE 203
Mailing Address - Street 2:
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97223-5481
Mailing Address - Country:US
Mailing Address - Phone:503-697-9777
Mailing Address - Fax:503-597-3708
Practice Address - Street 1:9735 SW SHADY LN STE 203
Practice Address - Street 2:
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97223-5481
Practice Address - Country:US
Practice Address - Phone:503-697-9777
Practice Address - Fax:503-597-3708
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-13
Last Update Date:2010-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD10790174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty