Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204E00000X | Oral & Maxillofacial Surgeon | FE177091 | OR |
NPI | 1053864561 |
---|---|
Provider Name | Dr. Karl Cuddy |
First Address | Portland, OR 97227-1623 |
Second Address | Portland, OR 97227-1623 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/08/2016 |
Last Update Date | 01/08/2016 |