King, Grayden Woodruff

King, Grayden Woodruff is an sole proprietor health care provider with primary practice located at 831 Nw Council Dr Ste 203, Gresham OR 97030-3721. He recently has only one registered license in Podiatric Medicine & Surgery Service Providers / Foot & Ankle Surgery, which is considered as his primary health care specialty. King, Grayden Woodruff can be contacted via phone (503) 667-6600.

Contact Information

Primary practice address
831 Nw Council Dr Ste 203 Gresham OR 97030-3721
Phone: (503) 667-6600
Fax: (503) 667-6608
Website:
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Health care specialties

SpecialtyCodeLicense #State
Podiatric Medicine & Surgery Service Providers / Foot & Ankle Surgery 213ES0103X DP 00436 Oregon

Profile Details

NPI number 1851587364
LBN Legal business name King, Grayden Woodruff
Credentials Doctor of Podiatric Medicine (DPM)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Sep 18th, 2007
Last updated Dec 28th, 2017 - about 7 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1851587364 NPPES
Oregon Other R141926 MEDICARE PTAN
Oregon MEDICAID 377694002 MEDICARE PTAN
Oregon MEDICAID 377694001 MEDICARE PTAN

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