Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0100X | Gastroenterologist | MD156950 | OR |
NPI | 1033322128 |
---|---|
Provider Name | Dr. Elliot Joo |
First Address | Portland, OR 97232-2686 |
Second Address | Portland, OR 97225-6689 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/05/2007 |
Last Update Date | 01/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2028722 | (05) | WA |
500646438 | (05) | OR |