Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207VG0400X | Gynecologist | MD 10947 | OR |
NPI | 1043309685 |
---|---|
Provider Name | Bertha Moseson |
First Address | Oregon City, OR 97045-4076 |
Second Address | Oregon City, OR 97045-4076 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/10/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C91592 | (02) | OR |