Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207N00000X | Dermatologist | MD00041910 | WA |
Y | 207N00000X | Dermatologist | MD24345 | OR |
N | 207ND0900X | Dermatopathologist | MD00041910 | WA |
N | 207ND0900X | Dermatopathologist | MD24345 | OR |
N | 207NS0135X | Procedural Dermatology | MD00041910 | WA |
N | 207NS0135X | Procedural Dermatology | MD24345 | OR |
NPI | 1407851363 |
---|---|
Provider Name | Dr. Bernard A Gasch |
First Address | Portland, OR 97225-6652 |
Second Address | Portland, OR 97225-6652 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/06/2005 |
Last Update Date | 08/09/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
232506 | (05) | OR |
H90394 | (02) |