Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TH0100X | Health Service | 1663 | OR |
NPI | 1194738013 |
---|---|
Provider Name | Dr. Julie A Shafer |
First Address | Portland, OR 97227-1476 |
Second Address | Portland, OR 97227-1476 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/08/2006 |
Last Update Date | 07/02/2019 |