Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207YS0123X | Facial Plastic Surgeon | 00034631 | WA |
Y | 207YS0123X | Facial Plastic Surgeon | 10701 | OR |
NPI | 1891801551 |
---|---|
Provider Name | Dr. Jeffrey Morris Israel |
First Address | Portland, OR 97219-4475 |
Second Address | Portland, OR 97219-4475 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/08/2006 |
Last Update Date | 04/01/2010 |