Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | D5976 | OR |
NPI | 1063482586 |
---|---|
Provider Name | Dr. Blaine E. Mowrey |
First Address | Hillsboro, OR 97124-5611 |
Second Address | Portland, OR 97266-4661 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/01/2006 |
Last Update Date | 24/10/2018 |