Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VX0000X | Obstetrician | MD171507 | OR |
NPI | 1386935609 |
---|---|
Provider Name | Carmen M Doom |
First Address | Portland, OR 97210-2976 |
Second Address | Portland, OR 97210 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/04/2011 |
Last Update Date | 29/03/2019 |