Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 306286 | LA |
N | 111NI0900X | Internist | 306286 | LA |
N | 207RP1001X | Pulmonary Disease | 63518 | MN |
Y | 207RP1001X | Pulmonary Disease | MD203514 | OR |
NPI | 1013344506 |
---|---|
Provider Name | Cameron Miles Long |
First Address | Portland, OR 97232-2686 |
Second Address | Portland, OR 97225-6667 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/09/2013 |
Last Update Date | 23/11/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2176076 | (05) | WA |
500791905 | (05) | OR |