Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RC0000X | Internist - Cardiovascular Disease | G58715 | CA |
N | 207RC0000X | Internist - Cardiovascular Disease | MD00037964 | WA |
Y | 207RC0000X | Internist - Cardiovascular Disease | MD22025 | OR |
NPI | 1023236783 |
---|---|
Provider Name | Daniel Philip Lavery |
First Address | West Linn, OR 97068-9291 |
Second Address | Clackamas, OR 97015-8970 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/04/2007 |
Last Update Date | 01/02/2022 |