Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RR0500X | Rheumatology | MD13316 | OR |
NPI | 1053411660 |
---|---|
Provider Name | Dr. Gary L Sultany |
First Address | Portland, OR 97225-6630 |
Second Address | Portland, OR 97225-6630 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/09/2006 |
Last Update Date | 20/06/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
267799 | (05) | OR |
C93883 | (02) | OR |