Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | MD151732 | OR |
N | 111NI0900X | Internist | MD151732 | OR |
N | 207RC0200X | Critical Care Medicine | MD151732 | OR |
Y | 207RP1001X | Pulmonary Disease | MD151732 | OR |
NPI | 1003019621 |
---|---|
Provider Name | Donald Richard Sullivan |
First Address | Portland, OR 97239-3011 |
Second Address | Portland, OR 97239-3011 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/06/2007 |
Last Update Date | 31/10/2013 |