Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | A117720 | CA |
Y | 2080P0203X | Pediatric Critical Care Doctor | MD177563 | OR |
NPI | 1255659801 |
---|---|
Provider Name | Dr. Benjamin Edward Orwoll |
First Address | Portland, OR 97239-3011 |
Second Address | Portland, OR 97239-3107 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/05/2010 |
Last Update Date | 17/03/2018 |