Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1700X | Ocularist | MD07309 | OR |
NPI | 1457579468 |
---|---|
Provider Name | Dr. Donald Allen Burress |
First Address | Gresham, OR 97030-5612 |
Second Address | Gresham, OR 97030-5612 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/04/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C92329 | (02) | OR |