Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207VG0400X | Gynecologist | MD 23534 | OR |
N | 207VX0000X | Obstetrician | MD 23534 | OR |
NPI | 1033113055 |
---|---|
Provider Name | Dr. Jonathan Edward Pugmire |
First Address | Salem, OR 97301-2750 |
Second Address | Salem, OR 97301-2750 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/06/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
286501 | (05) | OR |
H69627 | (02) |