Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | 387 | OR |
NPI | 1326136110 |
---|---|
Provider Name | Byron N Fujita |
First Address | Oregon City, OR 97045-1824 |
Second Address | Oregon City, OR 97045-1824 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/10/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
R93815 | (02) | OR |