Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2082S0105X | Plastic Hand Surgeon | 23806 | OR |
N | 2086S0122X | Plastic and Reconstructive Surgery | 23806 | OR |
NPI | 1295863520 |
---|---|
Provider Name | Dr. Geoffrey Harry Buncke |
First Address | Portland, OR 97210 |
Second Address | Portland, OR 97209 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/02/2007 |
Last Update Date | 25/06/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
23806 | STATE LICENSE (01) | OR |
E39901 | (02) | CA |