Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Gresham Internal Medicine Clinic

Organization Internal Medicine Physician · NPI 1134204340

Gresham Internal Medicine Clinic is an Internal Medicine Physician in Gresham, Oregon. Licensed in Oregon. Registered with an NPI since 2006.

Licensed in
OR
In the registry since
2006

Practice location Address checks out

24900 SE Stark St Ste 109
Gresham, OR 97030-3381
Phone: (503) 667-1015
Fax: (503) 667-0406
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Internal Medicine Physician (primary) Taxonomy 207R00000X · Licence 01794 (OR)

Record details

NPI number1134204340
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official John Custis — Owner/Partner · (503) 667-1015
NPI enumeratedOctober 26, 2006
Last updated in NPPESDecember 11, 2008
Mailing addressPo Box 23200, Portland, OR 97281-3200

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