Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207T00000X | Neurosurgeon | PA172323 | OR |
NPI | 1093117228 |
---|---|
Provider Name | Caitlin Hodges Dedeaux |
First Address | Portland, OR 97201-5052 |
Second Address | Portland, OR 97239-4501 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/09/2014 |
Last Update Date | 30/10/2015 |