Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | MD184711 | OR |
Y | 208600000X | Surgeon | MD184711 | OR |
N | 2086S0102X | Surgical Critical Care | MD184711 | OR |
NPI | 1245524479 |
---|---|
Provider Name | Dr. Megan Rose Lundeberg |
First Address | Portland, OR 97227-2003 |
Second Address | Portland, OR 97227-2003 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/06/2011 |
Last Update Date | 17/03/2018 |