Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208G00000X | Cardiothoracic Vascular Surgeon | 6808 | MT |
N | 208G00000X | Cardiothoracic Vascular Surgeon | G15870 | CA |
N | 208G00000X | Cardiothoracic Vascular Surgeon | MD00020667 | WA |
Y | 208G00000X | Cardiothoracic Vascular Surgeon | MD08494 | OR |
N | 208G00000X | Cardiothoracic Vascular Surgeon | R3034 | MO |
NPI | 1124010509 |
---|---|
Provider Name | Albert Henry Krause |
First Address | Portland, OR 97214-1308 |
Second Address | Portland, OR 97210-3033 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/08/2005 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
233791 | (05) | OR |
8291601 | (05) | WA |
D94336 | (02) | OR |