Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0106X | Oral and Maxillofacial Pathology | D8283 | OR |
NPI | 1669435806 |
---|---|
Provider Name | Dr. Bryan R. Harvey |
First Address | Oregon City, OR 97045-4045 |
Second Address | Oregon City, OR 97045-4045 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/04/2006 |
Last Update Date | 08/07/2007 |