Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207K00000X | Allergist & Immunologist | MD00019556 | WA |
Y | 207K00000X | Allergist & Immunologist | MD09504 | OR |
N | 207KA0200X | Allergist | MD00019556 | WA |
N | 207KA0200X | Allergist | MD09504 | OR |
N | 207RR0500X | Rheumatology | MD09504 | OR |
NPI | 1013913409 |
---|---|
Provider Name | Dr. Clifford Joe Anderson |
First Address | Portland, OR 97209-2630 |
Second Address | Portland, OR 97209-2630 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/06/2005 |
Last Update Date | 22/08/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
004028 | (05) | OR |
C92092 | (02) |