Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | MD | OR |
NPI | 1043233570 |
---|---|
Provider Name | Dr. Mark Eric Hosko |
First Address | Gresham, OR 97030-0167 |
Second Address | Gresham, OR 97080-1494 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/07/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C92902 | (02) | OR |