Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | PG198892 | OR |
Y | 208600000X | Surgeon | PG198892 | OR |
NPI | 1003436841 |
---|---|
Provider Name | Dr. Issac Robert Schwantes |
First Address | Portland, OR 97239-3011 |
Second Address | Portland, OR 97239-3011 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/04/2020 |
Last Update Date | 24/04/2020 |