Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207T00000X | Neurosurgeon | LL 17503 | OR |
NPI | 1033388830 |
---|---|
Provider Name | Dibyendu K Ray |
First Address | Portland, OR 97239-3098 |
Second Address | Portland, OR 97239-3098 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/02/2008 |
Last Update Date | 23/07/2009 |