Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | MD22287 | OR |
Y | 2080P0216X | Pediatric Rheumatologist | MD22287 | OR |
NPI | 1396705414 |
---|---|
Provider Name | Dr. Daniel Joseph Kingsbury |
First Address | Portland, OR 97227-2005 |
Second Address | Portland, OR 97227-2005 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/03/2006 |
Last Update Date | 28/01/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
288457 | (05) | OR |
H71229 | (02) | OR |