Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | MD23365 | OR |
N | 208600000X | Surgeon | MD23365 | OR |
N | 2086S0102X | Surgical Critical Care | MD23365 | OR |
N | 2086S0127X | Trauma Surgeon | MD23365 | OR |
NPI | 1407964968 |
---|---|
Provider Name | Dr. Mark Steven Kestner |
First Address | Portland, OR 97227-1623 |
Second Address | Portland, OR 97227-1654 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/08/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
287209 | (05) | OR |
F77694 | (02) | OR |