Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RH0000X | Hematologist | A126611 | CA |
Y | 207RX0202X | Medical Oncology | MD191240 | OR |
NPI | 1235405317 |
---|---|
Provider Name | Dr. Derek Galligan |
First Address | Portland, OR 97239-3011 |
Second Address | Portland, OR 97239-3011 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/03/2012 |
Last Update Date | 21/03/2019 |