Provider Demographics
NPI:1174764864
Name:OSWALD, GARY W (LAC)
Entity type:Individual
Prefix:
First Name:GARY
Middle Name:W
Last Name:OSWALD
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:234 SE 43RD AVE
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97123-5915
Mailing Address - Country:US
Mailing Address - Phone:503-747-9618
Mailing Address - Fax:
Practice Address - Street 1:11385 SW SCHOLLS FERRY RD
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97008-7167
Practice Address - Country:US
Practice Address - Phone:503-747-9618
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-10
Last Update Date:2009-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC01276171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist