Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204D00000X | Neuromusculoskeletal Medicine (NMM) | DO27920 | OR |
Y | 207Q00000X | Family Doctor | DO27920 | OR |
NPI | 1629025473 |
---|---|
Provider Name | Dr. Eric William Shilland |
First Address | Portland, OR 97202-6662 |
Second Address | Portland, OR 97202-6662 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/05/2006 |
Last Update Date | 06/11/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1629025473 | (05) | WA |
226982 | (05) | OR |
E55318 | (02) | |
E55318 | (02) | ME |