Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204C00000X | Sports Medicine Doctor | OR |
NPI | 1245371269 |
---|---|
Provider Name | Alec W. Volvovic |
First Address | Portland, OR 97236-4799 |
Second Address | Clackamas, OR 97015-8970 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/02/2007 |
Last Update Date | 08/07/2007 |