Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | MD151644 | OR |
Y | 207XS0106X | Orthopaedic Hand Surgeon | MD151644 | OR |
NPI | 1275649162 |
---|---|
Provider Name | Dominic Patrick Patillo |
First Address | Portland, OR 97209-2539 |
Second Address | Portland, OR 97216-2448 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/08/2006 |
Last Update Date | 25/02/2016 |