Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | 769 | OR |
Y | 103TC0700X | Clinical Psychologist | 769 | OR |
NPI | 1003055278 |
---|---|
Provider Name | Dr. Douglas L Dunlap |
First Address | Portland, OR 97232-2043 |
Second Address | Portland, OR 97232-2043 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/02/2009 |
Last Update Date | 11/02/2009 |