Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0106X | Oral and Maxillofacial Pathology | D4283 | OR |
NPI | 1063413722 |
---|---|
Provider Name | Dr. Henry Cooke Windell |
First Address | Gresham, OR 97030-8317 |
Second Address | Gresham, OR 97030-8316 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/08/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T68273 | (02) | OR |