Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204F00000X | Transplant Surgeon | MD174551 | OR |
N | 208200000X | Surgeon | MD174551 | OR |
N | 208600000X | Surgeon | MD174551 | OR |
NPI | 1629369756 |
---|---|
Provider Name | Christopher Robert Connelly |
First Address | Portland, OR 97239-3011 |
Second Address | Portland, OR 97239-3011 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/04/2011 |
Last Update Date | 24/07/2020 |