Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Y00000X | Otolaryngologist (ENT Doctor) | MD203810 | OR |
Y | 207YX0007X | Plastic Surgeon (Head & Neck) | MD203810 | OR |
NPI | 1275982431 |
---|---|
Provider Name | Dr. Garren Michael Iida Low |
First Address | Portland, OR 97239-4501 |
Second Address | Portland, OR 97239-4501 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/06/2016 |
Last Update Date | 02/06/2021 |