Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0207X | Pediatric Hematology-Oncologist | MD11878 | OR |
NPI | 1073521514 |
---|---|
Provider Name | David Lee Tilford |
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 | 03/08/2006 |
Last Update Date | 14/08/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
245100 | (05) | OR |
C91753 | (02) |