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Contact Information

MICHAEL R CLARK
4212 SE DIVISION ST STE 100
PORTLAND, OR97206-1680
 Phone: 503-238-0705
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Technician

374700000X
Indicates primary specialty

NPI Profile & details for MICHAEL R CLARK · (Male)

NPI Number 1801613344
Status Active
Credentials
Entity Individual
Enumeration date 09/25/2024
Last updated 09/25/2024 - More than a year ago
Sole proprietor 1 No
Identifiers Not Available
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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