Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PE0004X | Emergency Medical Services | ME82939 | FL |
N | 207Q00000X | Family Doctor | MD126278 | OR |
NPI | 1083648984 |
---|---|
Provider Name | Brian Thomas Paskowski |
First Address | Portland, OR 97208-3158 |
Second Address | Portland, OR 97229-0973 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/07/2006 |
Last Update Date | 13/04/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
500616009 | (05) | OR |