Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 175F00000X | Naturopath | 1828 | OR |
NPI | 1043594518 |
---|---|
Provider Name | Dr. Dave Allderdice |
First Address | Lake Oswego, OR 97034-3228 |
Second Address | Lake Oswego, OR 97034-3228 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/10/2011 |
Last Update Date | 03/10/2011 |