Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207L00000X | Anesthesiologist | MD151341 | OR |
NPI | 1013182203 |
---|---|
Provider Name | Dr. Jeffrey Philip Mako |
First Address | Seattle, WA 98124-5147 |
Second Address | Portland, OR 97205-3536 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/04/2008 |
Last Update Date | 18/10/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
500654916 | (05) | OR |