Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0122X | Plastic and Reconstructive Surgery | MD21595 | OR |
NPI | 1184767238 |
---|---|
Provider Name | Daniel Alan Ladizinsky |
First Address | Clackamas, OR 97015-9777 |
Second Address | Clackamas, OR 97015-9777 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/02/2007 |
Last Update Date | 11/07/2008 |