Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | 5658 | OR |
NPI | 1891163515 |
---|---|
Provider Name | Dr. Andrew Joseph Funk |
First Address | Portland, OR 97225-5923 |
Second Address | Portland, OR 97225-5923 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/09/2015 |
Last Update Date | 14/03/2017 |