Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | MD162188 | OR |
N | 207X00000X | Orthopaedic Surgeon | MD162188 | OR |
Y | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | MD162188 | OR |
NPI | 1114242005 |
---|---|
Provider Name | Dr. Alexander Matthew Dehaan |
First Address | Portland, OR 97225-5914 |
Second Address | Portland, OR 97225-5914 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/04/2010 |
Last Update Date | 02/06/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
50065415 | (05) | OR |
MD162188 | LICENSE NUMBER (01) | OR |