Leland Matthew Piccolo PAC

NPI 1114116993 - Physician Assistant - 363A00000X

NPI Details
NPI 1114116993
Gender Male
Enumeration Date 10/17/2007
Last Updated 09/13/2013
Entity Type Individual
Active Over 9 years ago
Practice Location
9155 SW BARNES RD
SUITE 440
PORTLAND OR, 97225-6625, US
Phone (503) 297-3766
Fax (503) 297-8148
Business Location
847 NE 19TH AVE
SUITE 300
PORTLAND OR, 97232-2684, US
Phone (503) 963-2801
Fax (503) 963-2825
Toxanomy
Taxonomy Code 363A00000X
License State Oregon
License Number PA01395
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According to our database, Mr. Leland Matthew Piccolo PAC NPI is 1114116993, taxonomy code is 363A00000X and license number is PA01395, license state is located at Oregon. Leland Matthew Piccolo PAC physically located at 9155 Sw Barnes Rd, Portland OR, 97225-6625. NPI Number Leland Matthew Piccolo PAC has the Individual type.

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1114116993 NPI number is provided on an as is basis without warranty of any kind. 1114116993 is maintained by the National Plan & Provider Enumeration System. The contents of Leland Matthew Piccolo PAC are for informational purposes only.