Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207KA0200X | Allergist | MD19573 | OR |
Y | 207RG0100X | Gastroenterologist | MD19573 | OR |
NPI | 1225034937 |
---|---|
Provider Name | Dr. Douglas A Shumaker |
First Address | Portland, OR 97232-2684 |
Second Address | Portland, OR 97225-6689 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/06/2005 |
Last Update Date | 01/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
287462 | (05) | OR |
8502510 | (05) | WA |
H49032 | (02) | OR |