Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | MD188398 | OR |
N | 207QS0010X | Family Doctor - Sports Medicine | MD188398 | OR |
NPI | 1023424256 |
---|---|
Provider Name | Dr. Jeffrey C Dart |
First Address | Milwaukie, OR 97269-2075 |
Second Address | Vancouver, WA 98663-2776 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/07/2014 |
Last Update Date | 08/08/2018 |