Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 57012374 | OH |
Y | 207Q00000X | Family Doctor | MD29054 | OR |
NPI | 1003081241 |
---|---|
Provider Name | Brian Michael Lindeman |
First Address | Portland, OR 97205-1902 |
Second Address | Portland, OR 97213 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/04/2008 |
Last Update Date | 16/11/2020 |