Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080N0001X | Neonatal-Perinatal Doctor | MD17692 | OR |
NPI | 1134292394 |
---|---|
Provider Name | Dr. Igor Michael Gladstone II |
First Address | Springfield, OR 97477-8800 |
Second Address | Springfield, OR 97477-8800 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/11/2006 |
Last Update Date | 23/10/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
042841 | (05) | OR |