Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NS0005X | Chiropractic Sports Physician | 3598 | OR |
NPI | 1275673808 |
---|---|
Provider Name | Dr. Guillermo J Bermudez |
First Address | Beaverton, OR 97005-4649 |
Second Address | Beaverton, OR 97005-4649 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/02/2007 |
Last Update Date | 08/07/2007 |