Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RX0202X | Medical Oncology | MD21475 | OR |
NPI | 1053314633 |
---|---|
Provider Name | Dr. Edward Weilie Soo |
First Address | Portland, OR 97213-2982 |
Second Address | Portland, OR 97213-2982 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/05/2005 |
Last Update Date | 14/03/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1001220 | (05) | WA |
130057 | (05) | OR |
F46212 | (02) | OR |