Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 0101242313 | VA |
Y | 2080P0207X | Pediatric Hematology-Oncologist | MD150195 | OR |
NPI | 1053526210 |
---|---|
Provider Name | Dr. Jason M Glover |
First Address | Portland, OR 97227-1623 |
Second Address | Portland, OR 97227-1623 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/05/2007 |
Last Update Date | 04/12/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1053526210 | (05) | VA |