Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QG0300X | Family Doctor - Geriatric Medicine | 03540 | IA |
NPI | 1356454631 |
---|---|
Provider Name | Debra Studer |
First Address | La Grande, OR 97850-0460 |
Second Address | La Grande, OR 97850-1906 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/08/2006 |
Last Update Date | 07/01/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2448845 | (05) | IA |
I09634 | (02) | IA |