Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XP3100X | Pediatric Orthopaedic Surgeon | OR |
NPI | 1356566525 |
---|---|
Provider Name | Dr. Kate Benedict Deisseroth |
First Address | Portland, OR 97223-7568 |
Second Address | Portland, OR 97223-7568 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/04/2007 |
Last Update Date | 08/07/2007 |