Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | MD11457 | OR |
NPI | 1063448728 |
---|---|
Provider Name | Dr. Duane Allen Lundeberg |
First Address | Portland, OR 97232-2684 |
Second Address | Portland, OR 97210-3033 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/06/2006 |
Last Update Date | 12/10/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
268284 | (05) | OR |
26828-5 | (05) | OR |
C93186 | (02) | OR |