Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | 4962 | OR |
Y | 213EG0000X | General Practice | 4962 | OR |
NPI | 1003813304 |
---|---|
Provider Name | Dr. Leland W. Nebeker |
First Address | Eugene, OR 97405-2890 |
Second Address | Eugene, OR 97405-2890 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/06/2005 |
Last Update Date | 08/07/2007 |