Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0200X | Radiology | 272107 | OR |
Y | 213ER0200X | Radiology | 272107 | OR |
NPI | 1922137801 |
---|---|
Provider Name | Dr. Lawrence Timothy Sellers |
First Address | Portland, OR 97214 |
Second Address | Portland, OR 97216 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/03/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T92907 | (02) |