Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VF0040X | Female Pelvic Medicine and Reconstructive Surgeon | MD26368 | OR |
NPI | 1891712477 |
---|---|
Provider Name | Connie Sue Dimarco |
First Address | Springfield, OR 97477-1118 |
Second Address | Springfield, OR 97477-1118 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/07/2006 |
Last Update Date | 07/05/2013 |