Basic Information
| Provider Information | |||||||||
| NPI: | 1063570745 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | 24 ON PHYSICIANS PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 403631 | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303843631 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7707400895 | ||||||||
| FaxNumber: | 7707400896 | ||||||||
| Practice Location | |||||||||
| Address1: | 1500 DIVISION ST | ||||||||
| Address2: | |||||||||
| City: | OREGON CITY | ||||||||
| State: | OR | ||||||||
| PostalCode: | 970451527 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5036561631 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/05/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | FULLER | ||||||||
| AuthorizedOfficialFirstName: | DAN | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7707400895 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.