Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | MD178103 | OR |
N | 208600000X | Surgeon | MD178103 | OR |
Y | 2086S0129X | Vascular Surgeon | MD178103 | OR |
NPI | 1083662647 |
---|---|
Provider Name | Dr. Matthew C. Koopmann |
First Address | Portland, OR 97239-3011 |
Second Address | Portland, OR 97239-3011 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/05/2006 |
Last Update Date | 12/10/2016 |